Active NPI
Jennifer Black, OTR/L
- Pediatric Occupational Therapist
- Frostburg, MD
National Provider Identifier
1033666714
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- 08012
- Practice address
- 11046 New Georges Creek Rd SW
Frostburg, MD 21532-1448 - Phone
- (240) 284-2600
- NPI assigned
- Sep 9, 2016
- Last updated
- May 8, 2024
- 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 | 08012 | MD | Primary |
Addresses
Primary practice location
11046 New Georges Creek Rd SW
Frostburg, MD 21532-1448
Mailing address
11046 New Georges Creek Rd SW
Frostburg, MD 21532-1448
Phone (240) 284-2600
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 |
|---|---|---|---|
| 08012 | MD | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1473379200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715126400000",
"number": "1033666714",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11046 NEW GEORGES CREEK RD SW",
"city": "FROSTBURG",
"state": "MD",
"postal_code": "215321448",
"telephone_number": "240-284-2600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11046 NEW GEORGES CREEK RD SW",
"city": "FROSTBURG",
"state": "MD",
"postal_code": "215321448",
"telephone_number": "240-284-2600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "JENNIFER",
"name_prefix": "Mrs.",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-09-09",
"last_updated": "2024-05-08",
"certification_date": "2024-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "MD",
"license": "08012",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Frostburg, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.