Daniel Jackson, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

OTA18819 Issued in FL

Practice address

4208 Glenns Pass
Winter Haven, FL 33884-2443

Phone

(706) 699-2894

NPI assigned

Feb 15, 2016

Sex

Male

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

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

{
    "created_epoch": "1455494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664236800000",
    "number": "1780043091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4208 GLENNS PASS",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338842443",
            "telephone_number": "706-699-2894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4208 GLENNS PASS",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338842443",
            "telephone_number": "706-699-2894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DANIEL",
        "credential": "COTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-02-15",
        "last_updated": "2022-09-27",
        "certification_date": "2022-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "MO",
            "license": "2008034752",
            "primary": false
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "FL",
            "license": "OTA18819",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Esaam El-Dean Ismail, O.D.
• Sherif Isshak Ibrahim, MD
• J. Agustin Lacson M.D. Inc
• J&Y Assisted Living for the Ages
• Jackson Diagnostic Imaging, Inc
• Jillian J Jackson, LCSW
• Patrice Jackson
• Sarelyn Bertina Jackson
• Stephanie Kay Jackson
• Jared Jacobs, APRN

• Occupational Therapy Assistant in Winter Haven, FL
• Providers in Winter Haven, FL by specialty
• Occupational Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2022; 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.