Individual
MICHELLE M JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
116 ENTERPRISE CT, GREENWOOD, SC 29649-1666
(865) 392-2817
Mailing address
10133 SHERRILL BLVD STE 200, KNOXVILLE, TN 37932-3347
(978) 738-6102
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
018522-1
NY
225X00000X
Occupational Therapist
Primary
5256
SC
Other
Enumeration date
11/20/2014
Last updated
08/14/2023
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