Individual
MARY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
316 SHEPHERD ST, RALEIGH, NC 27607-4032
(919) 219-5653
Mailing address
316 SHEPHERD ST, RALEIGH, NC 27607-4032
(919) 219-5653
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
13329
NC
225X00000X
Occupational Therapist
OC020803
PA
Other
Enumeration date
01/08/2016
Last updated
07/29/2025
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