Miranda L Jackson, OTR/L
Occupational Therapist in Dearborn, MI. Individual provider (NPI-1).
NPI number1235718537
StatusActive
Last updated in NPPESSep 20, 2021
Details
- NPI
- 1235718537
- Entity type
- Individual (NPI-1)
- Name
- Miranda L Jackson
- Credential
- OTR/L
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Apr 5, 2021
- Certification date
- Sep 20, 2021
- Last updated
- Sep 20, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225X00000X | Occupational Therapist | – | MI | Yes |
| 225100000X | Physical Therapist | – | – |
Practice location
1360 Porter StDearborn, MI 48124-2890
Phone 313-689-5188
Mailing address
1360 Porter StDearborn, MI 48124-2890
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All 100 Occupational Therapist providers in Dearborn · All 7,276 providers in Dearborn
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