| NPI | 1497051924 |
|---|---|
| Former Name | MELINDA S JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00003731) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: WA OT00000455) |
| Enumeration Date | 2011-01-31 |
| Last Update Date | 2011-01-31 |