Healthcare Provider Details

I. General information

NPI: 1821223660
Provider Name (Legal Business Name): MALINDA ANNE JACKSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2009
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 MAIN ST
KANSAS CITY MO
64111-1921
US

IV. Provider business mailing address

3101 MAIN ST
KANSAS CITY MO
64111-1921
US

V. Phone/Fax

Practice location:
  • Phone: 816-841-2284
  • Fax: 816-753-7836
Mailing address:
  • Phone: 816-541-2284
  • Fax: 816-753-7836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number003979
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number17-01402
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: