Provider Demographics
NPI:1942517198
Name:JACKSON-HARRIS, AKEBA M (OTR)
Entity Type:Individual
Prefix:
First Name:AKEBA
Middle Name:M
Last Name:JACKSON-HARRIS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5408
Mailing Address - Street 2:
Mailing Address - City:MOSS POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39563-1408
Mailing Address - Country:US
Mailing Address - Phone:228-623-0838
Mailing Address - Fax:228-214-5539
Practice Address - Street 1:4813 KREOLE AVE
Practice Address - Street 2:
Practice Address - City:MOSS POINT
Practice Address - State:MS
Practice Address - Zip Code:39563-3532
Practice Address - Country:US
Practice Address - Phone:228-623-0838
Practice Address - Fax:228-214-5539
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT1357225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics