Provider Demographics
NPI:1588378566
Name:SIMPSON, JACKIE LEE (COTA/L)
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:LEE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 SILVER MAPLE CIR SW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-2502
Mailing Address - Country:US
Mailing Address - Phone:423-284-6011
Mailing Address - Fax:
Practice Address - Street 1:825 RUNYAN DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-1225
Practice Address - Country:US
Practice Address - Phone:423-875-6723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1322224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant