Provider Demographics
NPI:1588911317
Name:JACKSON-PENA, HEATHER ANNE (OTD, MOT, OTR/L, ETS)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:ANNE
Last Name:JACKSON-PENA
Suffix:
Gender:F
Credentials:OTD, MOT, OTR/L, ETS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 HUNGERFORD DR STE 9B
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-1750
Mailing Address - Country:US
Mailing Address - Phone:240-535-4036
Mailing Address - Fax:
Practice Address - Street 1:932 HUNGERFORD DR STE 9B
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1750
Practice Address - Country:US
Practice Address - Phone:240-535-4036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05710225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics