Active NPI
Courtney Jacob
- Pediatric Occupational Therapist
- Bend, OR
National Provider Identifier
1053299016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- 455975
- Practice address
- 120 SW Crowell Way Ste 100
Bend, OR 97702-3429 - Phone
- (541) 617-8769
- NPI assigned
- Aug 26, 2025
- Sex
- Unspecified or another gender identity
- 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 |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 455975 | OR | Primary |
Addresses
Primary practice location
120 SW Crowell Way Ste 100
Bend, OR 97702-3429
Mailing address
62909 Nasu Park Loop
Bend, OR 97701-9775
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 |
|---|---|---|---|
| 455975 | OR | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1756166400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1756166400000",
"number": "1053299016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "62909 NASU PARK LOOP",
"city": "BEND",
"state": "OR",
"postal_code": "977019775"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 SW CROWELL WAY STE 100",
"city": "BEND",
"state": "OR",
"postal_code": "977023429",
"telephone_number": "541-617-8769"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOB",
"first_name": "COURTNEY",
"sole_proprietor": "YES",
"sex": "X",
"enumeration_date": "2025-08-26",
"last_updated": "2025-08-26",
"certification_date": "2025-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "OR",
"license": "455975",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.