Individual
CANDICE ELIZABETH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
216 UNION CHURCH RD, CARTHAGE, NC 28327-7644
(910) 585-1912
Mailing address
422 HILL RD, SOUTHERN PINES, NC 28387-6637
(217) 254-6383
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
8007
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8007
NC BOARD OF OCCUPATIONAL THERAPY
NC
Enumeration date
08/23/2011
Last updated
08/23/2011
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