Provider Demographics
NPI:1518099191
Name:JACKSON, ARTIMEASE (MBA,OTRL)
Entity Type:Individual
Prefix:MS
First Name:ARTIMEASE
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MBA,OTRL
Other - Prefix:MRS
Other - First Name:ARTIMEASE
Other - Middle Name:JACKSON
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:504 CRESTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-5996
Mailing Address - Country:US
Mailing Address - Phone:770-498-4095
Mailing Address - Fax:
Practice Address - Street 1:504 CRESTWOOD CT
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-5996
Practice Address - Country:US
Practice Address - Phone:770-498-4095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000961225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics