Active NPI
Charyl Ladonne Jada Jack, OTR/L
- Occupational Therapist
- Bremerton, WA
National Provider Identifier
1033386529
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT60003424
- Practice address
- 1500 Shorewood Dr
Bremerton, WA 98312-2323 - Phone
- (360) 670-9327
- Fax
- (360) 343-1902
- NPI assigned
- May 13, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 | OT60003424 | WA | Primary |
Addresses
Primary practice location
1500 Shorewood Dr
Bremerton, WA 98312-2323
Mailing address
1500 Shorewood Dr
Bremerton, WA 98312-2323
Phone (360) 670-9327
Other practice location 1
4213 SW Colbert Way
Port Orchard, WA 98367-8808
Phone (360) 670-9327
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8957ST | Other | REGENCE |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | jadajack@gmail.com |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210636800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607644800000",
"number": "1033386529",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1500 SHOREWOOD DR",
"city": "BREMERTON",
"state": "WA",
"postal_code": "983122323",
"telephone_number": "360-670-9327",
"fax_number": "360-343-1902"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 SHOREWOOD DR",
"city": "BREMERTON",
"state": "WA",
"postal_code": "983122323",
"telephone_number": "360-670-9327",
"fax_number": "360-343-1902"
}
],
"practiceLocations": [
{
"address_1": "4213 SW Colbert Way",
"address_purpose": "LOCATION",
"city": "Port Orchard",
"state": "WA",
"postal_code": "983678808",
"country_code": "US",
"telephone_number": "360-670-9327",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACK",
"first_name": "CHARYL",
"middle_name": "LADONNE JADA",
"name_prefix": "Miss",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-13",
"last_updated": "2020-12-11",
"certification_date": "2020-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WA",
"license": "OT60003424",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE",
"identifier": "8957ST",
"state": null
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "jadajack@gmail.com",
"affiliation": "N",
"address_1": "1500 Shorewood Dr",
"city": "Bremerton",
"state": "WA",
"country_code": "US",
"postal_code": "983122323",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Bremerton, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.