Individual
KIA MARIA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
3048 RIVER OAK MEWS, DECATUR, GA 30034-6974
(404) 245-4631
Mailing address
3048 RIVER OAK MEWS, DECATUR, GA 30034-6974
(404) 245-4631
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA000733
GA
Other
Enumeration date
04/29/2010
Last updated
04/29/2010
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