Active NPI
Candace Doralee Jackson, COTA/L
- Occupational Therapy Assistant
- Ashdown, AR
National Provider Identifier
1962863381
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- OT-A 1072
- Practice address
- 1470 Rankin St
Ashdown, AR 71822-3806 - Phone
- (903) 824-6589
- NPI assigned
- Mar 11, 2016
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | OT-A 1072 | AR | Primary |
| Occupational Therapy Assistant | 224Z00000X | 213751 | TX |
Addresses
Primary practice location
1470 Rankin St
Ashdown, AR 71822-3806
Mailing address
1470 Rankin St
Ashdown, AR 71822-3806
Phone (903) 824-6589
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 |
|---|---|---|---|
| OT-A 1072 | AR | MD | Occupational Therapy Assistant |
| 213751 | TX | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1457654400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1457654400000",
"number": "1962863381",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1470 RANKIN ST",
"city": "ASHDOWN",
"state": "AR",
"postal_code": "718223806",
"telephone_number": "903-824-6589"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1470 RANKIN ST",
"city": "ASHDOWN",
"state": "AR",
"postal_code": "718223806",
"telephone_number": "903-824-6589"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "CANDACE",
"middle_name": "DORALEE",
"credential": "COTA/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-03-11",
"last_updated": "2016-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "AR",
"license": "OT-A 1072",
"primary": true
},
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "TX",
"license": "213751",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ashdown, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.