Individual
KATIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6230 STATE RD, SALINE, MI 48176-9832
(734) 389-7871
Mailing address
9790 MEVIS DR, BRIGHTON, MI 48114-9606
(248) 508-7415
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2002507356
MI
Other
Enumeration date
12/07/2020
Last updated
12/07/2020
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