Individual
COURTNEY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
231 TREETOP DR # 301, FAYETTEVILLE, NC 28311-0606
(951) 870-5501
Mailing address
411 N BALLANCE ST, SAINT PAULS, NC 28384-1211
Taxonomy
Speciality
Code
Description
License number
State
224ZE0001X
Environmental Modification Occupational Therapy Assistant
Primary
13569
NC
Other
Enumeration date
01/23/2023
Last updated
01/23/2023
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