Individual
LAURA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CO
Contact information
Practice address
123 PROFESSIONAL PARK DR STE 100, MOORESVILLE, NC 28117-5516
(704) 799-9825
(704) 799-9826
Mailing address
123 PROFESSIONAL PARK DR STE 100, MOORESVILLE, NC 28117-5516
(704) 799-9825
(704) 799-9826
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
—
—
Other
Enumeration date
10/22/2012
Last updated
10/22/2012
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