Individual
JEREMY EDISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2300 COLEMAN RD, ANNISTON, AL 36207-6824
(256) 831-5730
Mailing address
2300 COLEMAN RD, ANNISTON, AL 36207-6824
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4178
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
224Z00000X
—
AL
Enumeration date
07/19/2018
Last updated
07/19/2018
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