MEDICARE: JORDAN JACKSON WRIGHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant

General Provider Information

NPI Number	:	1588828677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN JACKSON WRIGHT

Provider Business Mailing Address
First Line	:	2694 GOURDNECK VALLEY RD
Second Line	:
City	:	MALVERN
State	:	AR
Zip	:	72104-8381
Country	:	US
Telephone Number	:	501-844-7169
Fax Number	:

Provider Business Practice Location Address
First Line	:	2837 MALVERN AVE
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71901-8321
Country	:	US
Telephone Number	:	501-262-1724
Fax Number	:	501-262-6227

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2008
Last Update Date	:	07/17/2008

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Directions to “ JORDAN JACKSON WRIGHT ” Practice Location

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