Individual
MS. AMANDA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L CPAM
Contact information
Practice address
5305 RESERVE DR NE, BROOKHAVEN, GA 30319-5924
(770) 634-8410
Mailing address
5305 RESERVE DR NE, BROOKHAVEN, GA 30319-5924
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT006270
GA
Other
Enumeration date
02/17/2017
Last updated
02/17/2017
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