Active NPI
Judith Wolf Ivan, OTR
- Occupational Therapist
- San Jose, CA
National Provider Identifier
1003805987
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT 3233
- Practice address
- 5998 Pilgrim Ave
San Jose, CA 95129-4729 - Phone
- (408) 252-9086
- NPI assigned
- Oct 13, 2005
- Sex
- Female
- 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 | OT 3233 | CA | Primary |
Addresses
Primary practice location
5998 Pilgrim Ave
San Jose, CA 95129-4729
Mailing address
5998 Pilgrim Ave
San Jose, CA 95129-4729
Phone (408) 252-9086
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT 3233 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129161600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003805987",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5998 PILGRIM AVE",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951294729",
"telephone_number": "408-252-9086"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5998 PILGRIM AVE",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951294729",
"telephone_number": "408-252-9086"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IVAN",
"first_name": "JUDITH",
"middle_name": "WOLF",
"name_prefix": "Mrs.",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-10-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "OT 3233",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.