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Individual

MRS. KELLY JEAN JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
COTA

Contact information

Practice address
280 E MAIN ST, SUITE 132, NEWARK, DE 19711-7333
(302) 709-0440
(302) 709-0443
Mailing address
280 E MAIN ST, SUITE 132, NEWARK, DE 19711-7333
(302) 709-0440
(302) 709-0443

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
U20000941
DE

Other

Enumeration date
01/27/2009
Last updated
01/27/2009
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