Healthcare Provider Details

I. General information

NPI: 1780003343
Provider Name (Legal Business Name): JACKLYNN KNOTTS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6310 N MESA ST STE C1
EL PASO TX
79912-4555
US

IV. Provider business mailing address

6310 N MESA ST STE C1
EL PASO TX
79912-4555
US

V. Phone/Fax

Practice location:
  • Phone: 915-317-6827
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL305875
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number115963
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number115963
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number115963
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: