Provider Demographics
NPI:1740502178
Name:JACKSON, KATHERINE A (OTR/L)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:A
Last Name:JACKSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2906 CENTRAL ST # 294
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1283
Mailing Address - Country:US
Mailing Address - Phone:847-530-3507
Mailing Address - Fax:
Practice Address - Street 1:2934 CENTRAL ST
Practice Address - Street 2:STE C2
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-5201
Practice Address - Country:US
Practice Address - Phone:847-530-3507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XP0019X
IL056.003215225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation