Provider Demographics
NPI:1124462817
Name:JACKSON, CATHERINE PATRICIA (OTD, MSOT, OTR/L)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:PATRICIA
Last Name:JACKSON
Suffix:
Gender:F
Credentials:OTD, MSOT, OTR/L
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:PATRICIA
Other - Last Name:HALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2222 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7958
Mailing Address - Country:US
Mailing Address - Phone:800-944-9782
Mailing Address - Fax:610-438-2046
Practice Address - Street 1:4206 STAMMER PL
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-3302
Practice Address - Country:US
Practice Address - Phone:615-298-4555
Practice Address - Fax:615-298-4555
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2670225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist