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1760516116
JIMMY DEMARIO JACKSON
WINSTON SALEM, NC
NPI
1760516116
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225X00000X Occupational Therapist
(Licence: NC 5827)
Enumeration Date
2007-03-16
Last Update Date
2007-07-08
Business Address
Mr. JIMMY DEMARIO JACKSON OTRL
5755 SHATTALON DR
WINSTON SALEM, NC 27105-1332
Phone number: 336-744-2779
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Mailing Address
Mr. JIMMY DEMARIO JACKSON OTRL
1009 FILE ST
WINSTON SALEM, NC 27101-3230
Phone number: 336-331-2946
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