Active NPI
John Phillip Jackson, OTR
- Occupational Therapist
- Lubbock, TX
National Provider Identifier
1013043553
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 102473
- Practice address
- 7810 Avenue U Apt B
Lubbock, TX 79423-2430 - Phone
- (806) 778-9735
- NPI assigned
- Feb 26, 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 | 102473 | TX | Primary |
Addresses
Primary practice location
7810 Avenue U Apt B
Lubbock, TX 79423-2430
Mailing address
7810 Avenue U Apt B
Lubbock, TX 79423-2430
Phone (806) 778-9735
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8T0844 | Other | TX | BLUE CROSS INDIVIDUAL NO |
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 |
|---|---|---|---|
| 102473 | TX | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jackson Rehab Services, LLC | Occupational Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Occupational Therapist
- Lubbock, TX
- NPI 1669528857
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1242259200000",
"number": "1013043553",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7810 AVENUE U APT B",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "794232430",
"telephone_number": "806-778-9735"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7810 AVENUE U APT B",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "794232430",
"telephone_number": "806-778-9735"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JOHN",
"middle_name": "PHILLIP",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-26",
"last_updated": "2009-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TX",
"license": "102473",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS INDIVIDUAL NO",
"identifier": "8T0844",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lubbock, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.