Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | ND | |
N | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1003381054 |
---|---|
Provider Name | Briana Jackson |
First Address | Burlington, ND 58722-2026 |
Second Address | Minot, ND 58703-2811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2018 |
Last Update Date | 05/10/2018 |