IndividualActive
Tara Jackson, CPO
NPI 1851255764 · Prosthetist · Portland, ME
Provider details
- NPI number
- 1851255764
- Entity type
- Individual
- Primary specialty
- ProsthetistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Credential
- CPO
- Sex
- Female
- Sole proprietor
- No
- License
- CPO04857 (ME)
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Practice location
1274 Congress St
Portland, ME 04102-2111
Phone: (207) 774-1002
Approximate (ZIP-level) locationGet directions
Mailing address
1274 Congress St
Portland, ME 04102-2111
Registry dates
- Enumerated
- 2025-12-15
- Last updated
- 2025-12-15
- Certified
- 2025-12-15
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.