Provider Demographics
NPI:1831232818
Name:JACKSON, NINA MARIE PEREZ (MOT,OTR/L)
Entity type:Individual
Prefix:MRS
First Name:NINA
Middle Name:MARIE PEREZ
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MOT,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:1311 GRANITE CANYON RD
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CO
Mailing Address - Zip Code:80536-7646
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1311 GRANITE CANYON RD
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CO
Practice Address - Zip Code:80536-7646
Practice Address - Country:US
Practice Address - Phone:970-416-1398
Practice Address - Fax:970-482-8397
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics