Most Relevant Information
Provider Data
| NPI Number: | 1003009937 |
| Provider Name: | KEITH R JACKSON OTR/L |
| Entity Type: | Individual |
| Taxonomy Code: | 225X00000X |
| Specialty: | Occupational Therapist |
| License Number: | OT9471 |
Most Important Dates
| Enumeration Date: | 08/23/2007 |
| Last Updated: | 08/23/2007 |
Provider Practice Location
600 NORTH BLVD W
SUITE D
LEESBURG
FL
347485063
Practice Location Phone/Fax
| Phone: | 3527879300 |
| Fax: |
Provider Mailing Location
4024 EAGLE RIDGE RD
FRUITLAND PARK
FL
347315619
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |