Active NPI
Jessica Callaway, OT
- Occupational Therapist
- Urbana, IL
National Provider Identifier
1063170884
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 056012165
- Practice address
- 810 W Anthony Dr
Urbana, IL 61802-7431 - Phone
- (217) 383-3077
- NPI assigned
- Nov 30, 2021
- 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 | 056012165 | IL | Primary |
Addresses
Primary practice location
810 W Anthony Dr
Urbana, IL 61802-7431
Mailing address
611 W Park St
Urbana, IL 61801-2529
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 |
|---|---|---|---|
| 056012165 | IL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1638230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1638230400000",
"number": "1063170884",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "611 W PARK ST",
"city": "URBANA",
"state": "IL",
"postal_code": "618012529"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "810 W ANTHONY DR",
"city": "URBANA",
"state": "IL",
"postal_code": "618027431",
"telephone_number": "217-383-3077"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CALLAWAY",
"first_name": "JESSICA",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-11-30",
"last_updated": "2021-11-30",
"certification_date": "2021-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IL",
"license": "056012165",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Urbana, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.