Individual
BRIANA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M OTR/L
Contact information
Practice address
3120 4TH AVE NW, MINOT, ND 58703-2811
(701) 720-5355
Mailing address
141 VALLEY AVE APT 102A, BURLINGTON, ND 58722-2026
(701) 391-2263
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
ND
225XP0200X
Pediatric Occupational Therapist
—
—
Other
Enumeration date
10/05/2018
Last updated
10/05/2018
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