Provider Demographics
NPI:1780661959
Name:GRIFFIN, JACALYN ANN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JACALYN
Middle Name:ANN
Last Name:GRIFFIN
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 1:931 MALL RING RD
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-8515
Mailing Address - Country:US
Mailing Address - Phone:580-512-9881
Mailing Address - Fax:
Practice Address - Street 1:596 US HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-2958
Practice Address - Country:US
Practice Address - Phone:863-314-8555
Practice Address - Fax:863-453-4922
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT13765225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200114950AMedicare UPIN