Individual
JALISSA NICOLE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTD, OTR
Contact information
Practice address
3256 N VALDOSTA RD, VALDOSTA, GA 31602-1778
(229) 560-6944
(888) 450-0379
Mailing address
3256 N VALDOSTA RD, VALDOSTA, GA 31602-1778
(229) 560-6944
(888) 450-0379
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT009030
GA
Other
Enumeration date
02/01/2024
Last updated
02/01/2024
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