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1851255764
TARA JACKSON
PORTLAND, ME
NPI
1851255764
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
224P00000X Prosthetist
(Licence: ME CPO04857)
Enumeration Date
2025-12-15
Last Update Date
2025-12-15
Business Address
TARA JACKSON CPO
1274 CONGRESS ST
PORTLAND, ME 04102-2111
Phone number: 207-774-1002
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Mailing Address
TARA JACKSON CPO
1274 CONGRESS ST
PORTLAND, ME 04102-2111
Phone number: 207-774-1002
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