Individual provider Active NPI

Jessica Lynne Story, OTR/L

  • Pediatric Occupational Therapist
  • Lewiston, ME
National Provider Identifier
1063518447
Registry record updated Dec 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
License
OT1788 Issued in ME
Practice address
15 Strawberry Ave
Lewiston, ME 04240-5941
Phone
(207) 330-9236
NPI assigned
Sep 15, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Occupational Therapist 225XP0200X
Pediatric Occupational Therapist 225XP0200X OT1788 ME Primary

Addresses

Primary practice location

15 Strawberry Ave
Lewiston, ME 04240-5941

Mailing address

11 Hatch Rd
Lisbon, ME 04250-6211
Phone (207) 240-2355

Other identifiers 1

IdentifierTypeStateIssuer
418120099MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250117003017 ME Practitioner - Occupational Therapist in Private Practice 1052840188

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": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734220800000",
    "number": "1063518447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 HATCH RD",
            "city": "LISBON",
            "state": "ME",
            "postal_code": "042506211",
            "telephone_number": "207-240-2355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 STRAWBERRY AVE",
            "city": "LEWISTON",
            "state": "ME",
            "postal_code": "042405941",
            "telephone_number": "207-330-9236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STORY",
        "first_name": "JESSICA",
        "middle_name": "LYNNE",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-15",
        "last_updated": "2024-12-15",
        "certification_date": "2024-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "ME",
            "license": "OT1788",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "418120099",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewiston, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.