Provider Demographics
NPI:1326884222
Name:JACKSON, KARA (OTR/L)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 COUNTY ROAD 1320
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-0517
Mailing Address - Country:US
Mailing Address - Phone:256-339-6973
Mailing Address - Fax:
Practice Address - Street 1:261 COUNTY ROAD 1320
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0517
Practice Address - Country:US
Practice Address - Phone:256-339-6973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5781225XL0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow VisionGroup - Single Specialty