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Individual

ERICA LAKISHA JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OTR/L

Contact information

Practice address
212 FAIRVIEW PARK DR, DUBLIN, GA 31021-2547
(478) 275-9888
Mailing address
129 WOODLAND HEIGHTS RD, DUBLIN, GA 31021-0471
(678) 697-4669

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT005607
GA

Other

Enumeration date
07/23/2020
Last updated
07/23/2020
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