Active NPI
Maya Elizabeth Jackson, OTR/L
- Pediatric Occupational Therapist
- Saint Louis, MO
National Provider Identifier
1013613066
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- 2022045861
- Practice address
- 801 N 11TH St
Saint Louis, MO 63101-1015 - Phone
- (615) 031-4331
- NPI assigned
- Feb 1, 2023
- 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 |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 2022045861 | MO | Primary |
Addresses
Primary practice location
801 N 11TH St
Saint Louis, MO 63101-1015
Mailing address
5119 Jamieson Ave # 1F
Saint Louis, MO 63109-3031
Phone (636) 293-0483
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 |
|---|---|---|---|
| 2022045861 | MO | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1675209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675209600000",
"number": "1013613066",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5119 JAMIESON AVE # 1F",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631093031",
"telephone_number": "636-293-0483"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 N 11TH ST",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631011015",
"telephone_number": "615-031-4331"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MAYA",
"middle_name": "ELIZABETH",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-02-01",
"last_updated": "2023-02-01",
"certification_date": "2023-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "MO",
"license": "2022045861",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.