Provider Demographics
NPI:1285758326
Name:JACKSON, DANICA MONIQUE (MHS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:DANICA
Middle Name:MONIQUE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MHS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3418 FROSTMOOR PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-2172
Mailing Address - Country:US
Mailing Address - Phone:704-910-2161
Mailing Address - Fax:
Practice Address - Street 1:620 TOM HUNTER RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-5511
Practice Address - Country:US
Practice Address - Phone:704-900-5513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5610225X00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist