Provider Demographics
NPI:1245593185
Name:THAXTON, JAMIE ANN (COTA/L)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:ANN
Last Name:THAXTON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 KEYSVIEW CT APT 12
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-8049
Mailing Address - Country:US
Mailing Address - Phone:801-671-2787
Mailing Address - Fax:
Practice Address - Street 1:1780 KEYSVIEW CT APT 12
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-8049
Practice Address - Country:US
Practice Address - Phone:801-671-2787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7421723-4202224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant