Individual
KORIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2795 PILOT KNOB RD STE 100, EAGAN, MN 55121-1930
(651) 994-9644
Mailing address
2795 PILOT KNOB RD STE 100, EAGAN, MN 55121-1930
(651) 994-9644
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
105456
STATE OF MINNESOTA
MN
Enumeration date
04/06/2018
Last updated
04/06/2018
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