Individual
MR. DARRYL RAYNOR JACKSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1734 MARKET ST, HANNIBAL, MO 63401-4025
(573) 629-0321
Mailing address
1734 MARKET ST, HANNIBAL, MO 63401-4025
(573) 629-0321
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
201000472
MO
Other
Enumeration date
06/08/2012
Last updated
06/08/2012
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