Individual
KELLENE SHEY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1301 W MAITLAND BLVD, MAITLAND, FL 32751-4338
(407) 645-0034
Mailing address
315 HOWARD BLVD, LONGWOOD, FL 32750-4616
(407) 402-3203
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
9463
FL
Other
Enumeration date
03/14/2007
Last updated
01/10/2010
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