Individual
KELSEY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOTR/L
Contact information
Practice address
3901 BEAUBIEN ST, DETROIT, MI 48201
(816) 805-0963
Mailing address
30080 MANOR DR, MADISON HEIGHTS, MI 48071-2237
(816) 805-0963
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
17-03012
KS
225X00000X
Occupational Therapist
Primary
5201009867
MI
Other
Enumeration date
08/19/2015
Last updated
06/06/2018
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