Active NPI
Keith R Jackson, OTR/L
- Occupational Therapist
- Leesburg, FL
National Provider Identifier
1003009937
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT9471
- Practice address
- 600 North Blvd W
Suite D
Leesburg, FL 34748-5063 - Phone
- (352) 787-9300
- NPI assigned
- Aug 23, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT9471 | FL | Primary |
Addresses
Primary practice location
600 North Blvd W
Suite D
Leesburg, FL 34748-5063
Mailing address
4024 Eagle Ridge Rd
Fruitland Park, FL 34731-5619
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT9471 | FL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187827200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187827200000",
"number": "1003009937",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4024 EAGLE RIDGE RD",
"city": "FRUITLAND PARK",
"state": "FL",
"postal_code": "347315619"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 NORTH BLVD W",
"address_2": "SUITE D",
"city": "LEESBURG",
"state": "FL",
"postal_code": "347485063",
"telephone_number": "352-787-9300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KEITH",
"middle_name": "R",
"name_prefix": "Mr.",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-08-23",
"last_updated": "2007-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "OT9471",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Leesburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.