Individual
MALIA R. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTD, OTR/L
Contact information
Practice address
2130 ANDERSON MILL RD, AUSTELL, GA 30106-1806
(770) 941-8813
Mailing address
2130 ANDERSON MILL RD, AUSTELL, GA 30106-1806
(770) 941-8813
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT006033
GA
Other
Enumeration date
09/19/2018
Last updated
09/19/2018
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