Briana Jackson, M OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

Practice address

3120 4TH Ave NW
Minot, ND 58703-2811

Phone

(701) 720-5355

NPI assigned

Oct 5, 2018

Last updated

Oct 5, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in ND

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kelly Lon Drevecky, OT R/L

  • Pediatric Occupational Therapist
  • Minot, ND
  • NPI 1457303695
  Medicare reassignment
• Kelly Drevecky

  dba Prairie Therapy

  • Pediatric Occupational Therapist
  • Minot, ND
  • NPI 1629224860
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1538697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538697600000",
    "number": "1003381054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 VALLEY AVE APT 102A",
            "city": "BURLINGTON",
            "state": "ND",
            "postal_code": "587222026",
            "telephone_number": "701-391-2263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3120 4TH AVE NW",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587032811",
            "telephone_number": "701-720-5355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BRIANA",
        "credential": "M OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-05",
        "last_updated": "2018-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "ND",
            "license": null,
            "primary": true
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madina J Ismail
• It Takes a Village Pain Management Institute of New York
• Karen K Iverson, RPH
• Heather Lynn Ives, MSW, LMSW
• Envie M Jackson-Jones
• Kelci Lee Jackson, AU.D.
• Stacey Jackson
• Michelle F Jacob, LSW
• Seelia Jacob, DO
• Candy Jacobson, APRN-CNP

• Occupational Therapist in Minot, ND
• Providers in Minot, ND by specialty
• Occupational Therapist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.