Provider Demographics
NPI:1225895469
Name:JACOT, CHELSEA (OTA)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:JACOT
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 4TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-3104
Mailing Address - Country:US
Mailing Address - Phone:541-812-2600
Mailing Address - Fax:541-812-2617
Practice Address - Street 1:905 4TH AVE SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-3104
Practice Address - Country:US
Practice Address - Phone:541-812-2600
Practice Address - Fax:541-812-2617
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR409288224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant