Provider Demographics
NPI:1437591807
Name:JACOT, KRISTA LEA (MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:LEA
Last Name:JACOT
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:MS
Other - First Name:KRISTA
Other - Middle Name:LEA
Other - Last Name:PEKNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:2108 TAYLOR AVE
Mailing Address - Street 2:STE 1100
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4604
Mailing Address - Country:US
Mailing Address - Phone:402-371-7545
Mailing Address - Fax:402-379-0583
Practice Address - Street 1:2108 TAYLOR AVE STE 1100
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4642
Practice Address - Country:US
Practice Address - Phone:402-371-7545
Practice Address - Fax:402-379-0583
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1667225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099890005Medicare PIN