Active NPI
Jenna Rose Noe
- Occupational Therapist
- Bolivar, MO
National Provider Identifier
1053162255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 2021036745
- Practice address
- 1500 N Oakland Ave
Bolivar, MO 65613-3099 - Phone
- (417) 326-6000
- NPI assigned
- Mar 27, 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 2021036745 | MO | Primary |
Addresses
Primary practice location
1500 N Oakland Ave
Bolivar, MO 65613-3099
Mailing address
111 N Winnebago Dr
Lake Winnebago, MO 64034-9318
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 |
|---|---|---|---|
| 2021036745 | MO | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1711497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711497600000",
"number": "1053162255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 N WINNEBAGO DR",
"city": "LAKE WINNEBAGO",
"state": "MO",
"postal_code": "640349318"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 N OAKLAND AVE",
"city": "BOLIVAR",
"state": "MO",
"postal_code": "656133099",
"telephone_number": "417-326-6000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NOE",
"first_name": "JENNA",
"middle_name": "ROSE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-03-27",
"last_updated": "2024-03-27",
"certification_date": "2024-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MO",
"license": "2021036745",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bolivar, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 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.