Provider Demographics
NPI:1689068819
Name:ASHER, JACKIE (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:
Last Name:ASHER
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:DE PERALTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:4012 BOSTON CIR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-1537
Mailing Address - Country:US
Mailing Address - Phone:847-571-3546
Mailing Address - Fax:
Practice Address - Street 1:4012 BOSTON CIR
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-1537
Practice Address - Country:US
Practice Address - Phone:847-571-3546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA087219225X00000X
FLOT16835225X00000X
NE2438225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist