1346337615 NPI number — MR. JAMES JOHN JACKSON MS,OTR,CHT

Table of content: MR. JAMES JOHN JACKSON MS,OTR,CHT (NPI 1346337615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346337615 NPI number — MR. JAMES JOHN JACKSON MS,OTR,CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JACKSON
Provider First Name:
JAMES
Provider Middle Name:
JOHN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MS,OTR,CHT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346337615
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3903 NORTHDALE BLVD
Provider Second Line Business Mailing Address:
STE 111W
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33624-1864
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-418-7350
Provider Business Mailing Address Fax Number:
813-265-2504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9415 SUNSET DR
Provider Second Line Business Practice Location Address:
STE 111
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33173-5427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-507-8278
Provider Business Practice Location Address Fax Number:
813-265-2504
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OT 632 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: OT 632 . This is a "OT LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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