| NPI | 1417621319 |
|---|---|
| Former Name | TAYLOR NICOLE JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MS OT-3859) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: WV 2129) |
| Enumeration Date | 2021-08-04 |
| Last Update Date | 2021-08-04 |