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General NPI Number Information
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NPI Number | 1700245958
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Entity Type | Organization
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Legal Business Name | CINDY JACKSON CHILDREN'S THERAPY SERVICES
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Dates
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Enumeration Date | 02/16/2016
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Last Update Date | 02/16/2016
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Provider Practice Location Address
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Address Line | 46 ROXBURY CT
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City | CHESHIRE
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State | CT
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Zip | 06410-1511
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Country | US
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Telephone | 203-271-3288
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Fax | 203-591-1936
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Provider Business Mailing Address
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Address Line | 46 ROXBURY CT
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City | CHESHIRE
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State | CT
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Zip | 06410-1511
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Country | US
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Telephone | 203-271-3288
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Fax | 203-591-1936
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Authorized Official
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Title or Position | OWNER
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Name | CINDY JACKSON
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Credential |
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Telephone | 203-271-3288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 004457
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License Number State | CT
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