Individual
SHELIA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
2250 US HIGHWAY 43 STE 107, WINFIELD, AL 35594-8622
(205) 487-0540
(205) 487-0569
Mailing address
1908 FLINT RD SE, DECATUR, AL 35601-6031
(256) 340-9708
(256) 340-9624
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003819608
GROUP NPI
AL
05
—
529917620
—
AL
Enumeration date
06/24/2006
Last updated
05/15/2013
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