Individual
SHENIKA LAVERNE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.T.
Contact information
Practice address
251 US HIGHWAY 19 N, CAMILLA, GA 31730-1410
(229) 336-8255
(229) 336-5878
Mailing address
159 WINDING WAY APT A, LEESBURG, GA 31763-5097
(229) 336-8255
(229) 336-5878
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT002552
GA
Other
Enumeration date
05/16/2007
Last updated
07/08/2007
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