Individual
MR. JIMMY DEMARIO JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTRL
Contact information
Practice address
5755 SHATTALON DR, WINSTON SALEM, NC 27105-1332
(336) 744-2779
Mailing address
1009 FILE ST, WINSTON SALEM, NC 27101-3230
(336) 331-2946
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5827
NC
Other
Enumeration date
03/16/2007
Last updated
07/08/2007
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