DR. Jackie D Nickson, OTD, OTR/L

NPI #1356777411 in Horn Lake, Mississippi

Provider Information

NPI Number: 1356777411
Entity Type: Individual
Name: DR. Jackie D Nickson, OTD, OTR/L
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Occupational Therapist
Credential: OTD, OTR/L
Enumeration Date: Sep 20, 2013
Last Updated: Jan 12, 2014

Practice Location

Address: 6664 SINCLAIR DR
City: Horn Lake
State: Mississippi
ZIP Code: 38637-2598
Phone: (901) 230-4982

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Occupational Therapist	225X00000X	Primary
Physical Therapist	225100000X
Speech-Language Pathologist	235Z00000X
Occupational Therapy Assistant	224Z00000X
Physical Therapy Assistant	225200000X

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