Individual
BRENT CALEB JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
1100 GRANDVIEW DR, FLATWOODS, KY 41139-1024
(606) 836-3187
Mailing address
1102 HORN ST, ASHLAND, KY 41101-7138
(606) 694-3187
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
174107
KY
Other
Enumeration date
07/26/2017
Last updated
07/26/2017
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