NPI 1366267627

Tierra Leanne Jackson, TATTOOLICENSE

Practitioner Rehabilitation Practitioner Springfield, MO

Practice location

Address: 3322 S Campbell Ave # X, Springfield, MO 65807-4980
Phone: (417) 771-5540

Registered specialties (2)

Rehabilitation Practitioner Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225400000X Licence 2021043963 (MO)

Other Rehabilitation Practitioner providers in Missouri →

Other Technician

Technologists, Technicians & Other Technical Service Providers Taxonomy 247200000X Licence 2021043963 (MO)

Other Technician, Other providers in Missouri →

Registry record

NPI: 1366267627
Entity type: Individual
Sex (as registered): Female
NPI issued: 20 Nov 2024
Record last updated: 20 Nov 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.