Individual
COREY PATRICK JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
8517 PEACH TREE DR, SANFORD, NC 27330-9216
(225) 454-3055
Mailing address
8517 PEACH TREE DR, SANFORD, NC 27330-9216
(919) 885-4998
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
13353
NC
Other
Enumeration date
05/23/2023
Last updated
05/23/2023
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