Individual
MS. SALLY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.T.
Contact information
Practice address
5150 STILESBORO RD NW, SUITE 430, KENNESAW, GA 30152-7744
(770) 630-0053
(770) 218-2201
Mailing address
5150 STILESBORO RD NW, SUITE 430, KENNESAW, GA 30152-7744
(770) 630-0053
(770) 218-2201
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT001398
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000611289C
—
GA
Enumeration date
04/12/2007
Last updated
08/17/2016
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