Individual
KELLY ELISE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
8109 INTERSTATE 30, LITTLE ROCK, AR 72209-4840
(501) 562-5400
Mailing address
8109 INTERSTATE 30, LITTLE ROCK, AR 72209-4840
(501) 562-5400
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OT-A986
AR
Other
Enumeration date
07/24/2015
Last updated
07/24/2015
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