Provider Demographics
NPI:1497127310
Name:JACKSON THERAPY PARTNERS
Entity Type:Organization
Organization Name:JACKSON THERAPY PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COTA/L,CKTP
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RIVES
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L,CKTP
Authorized Official - Phone:716-490-2881
Mailing Address - Street 1:1212 SUMMER LN
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19465-8080
Mailing Address - Country:US
Mailing Address - Phone:716-490-2881
Mailing Address - Fax:
Practice Address - Street 1:1212 SUMMER LN
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19465-8080
Practice Address - Country:US
Practice Address - Phone:716-490-2881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP007639251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health