Provider Demographics
NPI:1760614499
Name:JACKO, DENISE (OTR/L)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:JACKO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:ANNE
Other - Last Name:VANDENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6927 OLD SEWARD HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-2283
Mailing Address - Country:US
Mailing Address - Phone:907-345-0050
Mailing Address - Fax:907-344-5103
Practice Address - Street 1:6927 OLD SEWARD HWY STE 100
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-2283
Practice Address - Country:US
Practice Address - Phone:907-345-0050
Practice Address - Fax:907-344-5103
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist