Individual
MS. CAROLYN ANECE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
2450 RIVERSIDE AVE, R102, MINNEAPOLIS, MN 55454-1450
(612) 273-7876
(612) 273-7101
Mailing address
2450 RIVERSIDE AVE, R102, MINNEAPOLIS, MN 55454-1450
(612) 273-7876
(612) 273-7101
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
104735
MN
Other
Enumeration date
02/04/2015
Last updated
02/04/2015
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