Individual
REVONDA VESS JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
100 SPAULDING RD STE 1, MARION, NC 28752-5116
(828) 442-4902
Mailing address
1914 SILVERS WELCH RD, OLD FORT, NC 28762-8745
(828) 442-8124
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5054
NC
Other
Enumeration date
02/24/2026
Last updated
02/24/2026
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