Active NPI
Jessica Walczak, OTR/L
- Occupational Therapist
- Show Low, AZ
National Provider Identifier
1063780443
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 2859
- Practice address
- 2200 E Show Low Lake Rd
Show Low, AZ 85901-7831 - Phone
- (928) 537-6537
- Fax
- (928) 537-7969
- NPI assigned
- Dec 13, 2011
- 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 | 2859 | AZ | Primary |
Addresses
Primary practice location
2200 E Show Low Lake Rd
Show Low, AZ 85901-7831
Mailing address
2200 E Show Low Lake Rd
Show Low, AZ 85901-7831
Phone (928) 537-6537
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 |
|---|---|---|---|
| 2859 | AZ | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1343088000000",
"number": "1063780443",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2200 E SHOW LOW LAKE RD",
"city": "SHOW LOW",
"state": "AZ",
"postal_code": "859017831",
"telephone_number": "928-537-6537",
"fax_number": "928-537-7969"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2200 E SHOW LOW LAKE RD",
"city": "SHOW LOW",
"state": "AZ",
"postal_code": "859017831",
"telephone_number": "928-537-6537",
"fax_number": "928-537-7969"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALCZAK",
"first_name": "JESSICA",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-12-13",
"last_updated": "2012-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "AZ",
"license": "2859",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Show Low, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.