Michelle W. Jackson, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT005232 Issued in GA

Practice address

1826 Veterans Blvd
Dublin, GA 31021-3620

Phone

(478) 272-1210

NPI assigned

Apr 15, 2009

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Integra Rehabilitation Agency, LLC

  • Rehabilitation Clinic/Center
  • Dalton, GA
  • NPI 1053414177
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1239753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618790400000",
    "number": "1033352323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1013 RIVERBURCH PKWY",
            "address_2": "SUITE 4",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307218887",
            "telephone_number": "866-261-8090",
            "fax_number": "706-226-7869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1826 VETERANS BLVD",
            "city": "DUBLIN",
            "state": "GA",
            "postal_code": "310213620",
            "telephone_number": "478-272-1210"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1013 Riverburch Pkwy",
            "address_2": "Suite 4",
            "address_purpose": "LOCATION",
            "city": "Dalton",
            "state": "GA",
            "postal_code": "307218887",
            "country_code": "US",
            "telephone_number": "866-261-8090 x3335",
            "fax_number": "706-226-7869",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MICHELLE",
        "middle_name": "W.",
        "name_prefix": "Mrs.",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-04-15",
        "last_updated": "2021-04-19",
        "certification_date": "2021-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "GA",
            "license": "OTA000528",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "GA",
            "license": "OT005232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Martavis Isaac, LPC
• Frederica L Island, LPN
• Tina Baker Ivey, CRC
• J.H. Harvey Co., LLC
• Erica Lakisha Jackson, OTR/L
• Mickey Jackson
• Nieka Jackson, PHARMD
• Charlene James
• Erin Chimere James
• Chelsea Holland Jarriel

• Occupational Therapist in Dublin, GA
• Providers in Dublin, GA by specialty
• Occupational Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.