Provider Demographics
NPI:1134090590
Name:JACKSON, SARA E (COTA/L)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:JACKSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 N YORK ST STE H
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-1442
Mailing Address - Country:US
Mailing Address - Phone:918-912-2796
Mailing Address - Fax:918-513-5808
Practice Address - Street 1:1805 N YORK ST STE H
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-1442
Practice Address - Country:US
Practice Address - Phone:918-912-2796
Practice Address - Fax:918-513-5808
Is Sole Proprietor?:No
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2767224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant