Active NPI
Sandra Lynn Jackson, COTA
- Occupational Therapy Assistant
- Massillon, OH
National Provider Identifier
1962529677
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- OTA706
- Practice address
- 435 Avis Ave NW
Massillon, OH 44646-3555 - Phone
- (330) 837-1741
- NPI assigned
- Mar 26, 2007
- 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 Therapy Assistant | 224Z00000X | OTA706 | OH | Primary |
Addresses
Primary practice location
435 Avis Ave NW
Massillon, OH 44646-3555
Mailing address
1614 Cedar Knoll Ave NW
Massillon, OH 44646
Phone (330) 830-3845
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 |
|---|---|---|---|
| OTA706 | OH | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1962529677",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1614 CEDAR KNOLL AVE NW",
"city": "MASSILLON",
"state": "OH",
"postal_code": "44646",
"telephone_number": "330-830-3845"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "435 AVIS AVE NW",
"city": "MASSILLON",
"state": "OH",
"postal_code": "446463555",
"telephone_number": "330-837-1741"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "SANDRA",
"middle_name": "LYNN",
"credential": "COTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "OH",
"license": "OTA706",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Massillon, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.