Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Trevis Shantell Jackson

Individual provider Occupational Therapy Assistant · NPI 1073321659

Trevis Shantell Jackson is an Occupational Therapy Assistant in Fairburn, Georgia. Licensed in Georgia. Registered with an NPI since 2024.

Licensed in
GA
In the registry since
2024
Specialties on file
2

Practice location Address checks out

7420 Mistydawn Dr
Fairburn, GA 30213-4330
Phone: (678) 361-8944
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Medicine & Rehabilitation Physician (primary) Taxonomy 208100000X · Licence OTA000749 (GA)
Occupational Therapy Assistant Taxonomy 224Z00000X · Licence OTA000749 (GA)

Record details

NPI number1073321659
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedDecember 27, 2024
Last updated in NPPESDecember 27, 2024
Certification dateDecember 27, 2024
Mailing address7420 Mistydawn Dr, Fairburn, GA 30213-4330

Other providers in Fairburn