Provider Demographics
NPI:1700245958
Name:CINDY JACKSON CHILDREN'S THERAPY SERVICES
Entity Type:Organization
Organization Name:CINDY JACKSON CHILDREN'S THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-271-3288
Mailing Address - Street 1:46 ROXBURY CT
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-1511
Mailing Address - Country:US
Mailing Address - Phone:203-271-3288
Mailing Address - Fax:203-591-1936
Practice Address - Street 1:46 ROXBURY CT
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-1511
Practice Address - Country:US
Practice Address - Phone:203-271-3288
Practice Address - Fax:203-591-1936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004457225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty