Active NPI
Corey Jackson
- Occupational Therapy Assistant
- McKinney, TX
National Provider Identifier
1215395637
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 215730
- Practice address
- 1650 S Stonebridge Dr
McKinney, TX 75072-5660 - Phone
- (972) 529-1420
- NPI assigned
- Jan 30, 2016
- Last updated
- Jul 2, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 215730 | TX | Primary |
Addresses
Primary practice location
1650 S Stonebridge Dr
McKinney, TX 75072-5660
Mailing address
1515 Home Park Dr
Allen, TX 75002-4585
Phone (401) 256-3463
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 215730 | TX | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1454112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719878400000",
"number": "1215395637",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1515 HOME PARK DR",
"city": "ALLEN",
"state": "TX",
"postal_code": "750024585",
"telephone_number": "401-256-3463"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1650 S STONEBRIDGE DR",
"city": "MCKINNEY",
"state": "TX",
"postal_code": "750725660",
"telephone_number": "972-529-1420"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "COREY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-01-30",
"last_updated": "2024-07-02",
"certification_date": "2024-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "TX",
"license": "215730",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McKinney, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.