Individual
MISS SHAWN NICHOLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1415 ROUTE 70 E, SUITE 103, CHERRY HILL, NJ 08034-2210
(800) 670-3893
(856) 482-8498
Mailing address
9252 ASHLAND WOODS LN, APT A2, LORTON, VA 22079-1805
(703) 339-0534
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Enumeration date
10/31/2007
Last updated
10/31/2007
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