IndividualActive
Tashata Jackson, COTA
NPI 1053892604 · Occupational Therapy Assistant · Kilgore, TX
Provider details
- NPI number
- 1053892604
- Entity type
- Individual
- Primary specialty
- Occupational Therapy AssistantRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Credential
- COTA
- Sex
- Female
- Sole proprietor
- No
- License
- 212080 (TX)
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Practice location
2700 S Henderson Blvd
Kilgore, TX 75662-4033
Phone: (903) 984-3511
Approximate (ZIP-level) locationGet directions
Mailing address
6860 Dallas Pkwy Ste 550
Plano, TX 75024-4252
Registry dates
- Enumerated
- 2018-08-22
- Last updated
- 2018-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.