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General NPI Number Information
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NPI Number | 1730033044
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Entity Type | Individual
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Provider Name | REVONDA VESS JACKSON OT
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Gender | Female
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Dates
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Enumeration Date | 02/24/2026
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Last Update Date | 02/24/2026
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Provider Practice Location Address
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Address Line | 100 SPAULDING RD STE 1
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City | MARION
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State | NC
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Zip | 28752-5116
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Country | US
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Telephone | 828-442-4902
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Fax |
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Provider Business Mailing Address
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Address Line | 1914 SILVERS WELCH RD
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City | OLD FORT
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State | NC
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Zip | 28762-8745
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Country | US
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Telephone | 828-442-8124
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5054
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License Number State | NC
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