Individual
MARK R JELLOUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
1401 BENJAMIN PKWY, GREENSBORO, NC 27408-4518
(336) 545-5000
(336) 545-3566
Mailing address
PO BOX 38008, GREENSBORO, NC 27438-8008
(336) 545-5000
(336) 545-3566
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4781
NC
Other
Enumeration date
04/10/2006
Last updated
08/03/2007
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