Individual
KIMBERLY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1219 DUNN AVE, DAYTONA BEACH, FL 32114-2405
(386) 255-4568
Mailing address
6088 SUMMERLAKE DR, PORT ORANGE, FL 32127-7254
(253) 961-7303
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
19785
FL
Other
Enumeration date
06/25/2019
Last updated
07/10/2024
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