Provider Demographics
NPI:1689141632
Name:JACKSON, BRITTANEY (OTR)
Entity Type:Individual
Prefix:MS
First Name:BRITTANEY
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 ALLENTOWN RD STE 410
Mailing Address - Street 2:
Mailing Address - City:CAMP SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20746-4565
Mailing Address - Country:US
Mailing Address - Phone:301-238-4788
Mailing Address - Fax:301-298-5442
Practice Address - Street 1:5801 ALLENTOWN RD STE 410
Practice Address - Street 2:
Practice Address - City:CAMP SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:20746-4565
Practice Address - Country:US
Practice Address - Phone:301-238-4788
Practice Address - Fax:301-298-5442
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08414225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist