Active NPI
Erica Lakisha Jackson, OTR/L
- Occupational Therapist
- Dublin, GA
National Provider Identifier
1710596978
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT005607
- Practice address
- 212 Fairview Park Dr
Dublin, GA 31021-2547 - Phone
- (478) 275-9888
- NPI assigned
- Jul 23, 2020
- Sex
- Female
- 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 Therapist | 225X00000X | OT005607 | GA | Primary |
Addresses
Primary practice location
212 Fairview Park Dr
Dublin, GA 31021-2547
Mailing address
129 Woodland Heights Rd
Dublin, GA 31021-0471
Phone (678) 697-4669
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT005607 | GA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1595462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595462400000",
"number": "1710596978",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "129 WOODLAND HEIGHTS RD",
"city": "DUBLIN",
"state": "GA",
"postal_code": "310210471",
"telephone_number": "678-697-4669"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "212 FAIRVIEW PARK DR",
"city": "DUBLIN",
"state": "GA",
"postal_code": "310212547",
"telephone_number": "478-275-9888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "ERICA",
"middle_name": "LAKISHA",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-07-23",
"last_updated": "2020-07-23",
"certification_date": "2020-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "GA",
"license": "OT005607",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dublin, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.