Basic Information
| Provider Information | |||||||||
| NPI: | 1568050987 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DIGGS | ||||||||
| FirstName: | JACQUELYNN | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5304 TANGLEWOOD PINE LN | ||||||||
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| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276103181 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 851 S BECKFORD DR STE A | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275365910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194807008 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2021 | ||||||||
| LastUpdateDate: | 01/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 13711 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.