Provider Demographics
NPI:1841454923
Name:JACKSON, MARGARET KAY (OTR/L)
Entity type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:KAY
Last Name:JACKSON
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 1:14065 LOTUS LN
Mailing Address - Street 2:APT. 1024
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-7401
Mailing Address - Country:US
Mailing Address - Phone:703-830-2271
Mailing Address - Fax:
Practice Address - Street 1:14065 LOTUS LN
Practice Address - Street 2:APT. 1024
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-7401
Practice Address - Country:US
Practice Address - Phone:703-830-2271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119001233225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist