Individual
MISS SHAWN RENE'E JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
201 E THOMPSON ST, DECATUR, TX 76234-2736
(940) 657-4500
Mailing address
201 E THOMPSON ST, DECATUR, TX 76234-2736
(940) 657-4500
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
211828
TX
Other
Enumeration date
01/22/2019
Last updated
01/22/2019
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