Provider Demographics
NPI:1801022777
Name:JACKURA, MONICA CARON (OT)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:CARON
Last Name:JACKURA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 W MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-3016
Mailing Address - Country:US
Mailing Address - Phone:530-668-1010
Mailing Address - Fax:
Practice Address - Street 1:96 W MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3016
Practice Address - Country:US
Practice Address - Phone:530-668-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2937225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics