Jacklyn L Locke, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT3892 Issued in ME

Practice address

16 Old Pike Rd
Cornish, ME 04020-3506

Phone

(207) 625-4300

Fax

(207) 625-7300

NPI assigned

Oct 13, 2020

Last updated

Dec 13, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jacklyn L Holmes Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1602547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639353600000",
    "number": "1609474584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 48",
            "city": "CORNISH",
            "state": "ME",
            "postal_code": "040200048",
            "telephone_number": "207-256-7303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 OLD PIKE RD",
            "city": "CORNISH",
            "state": "ME",
            "postal_code": "040203506",
            "telephone_number": "207-625-4300",
            "fax_number": "207-625-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOCKE",
        "first_name": "JACKLYN",
        "middle_name": "L",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-13",
        "last_updated": "2021-12-13",
        "certification_date": "2021-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "ME",
            "license": "OT3892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACKLYN",
            "last_name": "HOLMES",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Jessica M Larson, RPH
• Kevin Michael Ledue
• Diana Mains, LMT
• Cory Lynn Marcoux, PT, DPT
• Adam S McBride, D.C.
• Kristen L Pease, PT, DPT
• Ashley Lynn Pelletier, FNP

• Occupational Therapist in Cornish, ME
• Providers in Cornish, ME by specialty
• Occupational Therapist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 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.