EBONI MADLOCK

JACKSON, MS
NPI1568848166
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy225X00000X Occupational Therapist
(Licence: MS  3294)
Additional Taxonomies225X00000X Occupational Therapist
(Licence: TX  117075)
Enumeration Date2015-08-05
Last Update Date2021-06-21
Business Address
EBONI MADLOCK
1081 AUTUMN ST
JACKSON, MS 39212-2555
Phone number: 601-874-5741
Mailing Address
EBONI MADLOCK
1081 AUTUMN ST
JACKSON, MS 39212-2555
Phone number: