Provider Demographics
NPI:1689836686
Name:JACKSON THERAPY PARTNERS
Entity Type:Organization
Organization Name:JACKSON THERAPY PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:HOPE
Authorized Official - Middle Name:CHASITY
Authorized Official - Last Name:PRYOR
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:301-306-0135
Mailing Address - Street 1:11301 CORPORATE BLVD
Mailing Address - Street 2:SIUTE 101
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-8354
Mailing Address - Country:US
Mailing Address - Phone:877-896-3660
Mailing Address - Fax:900-778-7882
Practice Address - Street 1:11301 CORPORATE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-8354
Practice Address - Country:US
Practice Address - Phone:877-896-3660
Practice Address - Fax:900-778-7882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05773314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility