Individual provider Active NPI

Theresa V Jarvis, OT

  • Occupational Therapist
  • Michigan City, IN
National Provider Identifier
1063986677
Registry record updated Feb 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
31006115A Issued in IN
Practice address
3500 Franciscan Way Ste 400
Michigan City, IN 46360-0021
Phone
(219) 214-4516
Fax
(219) 861-5725
NPI assigned
Jan 16, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 31006115A IN Primary

Addresses

Primary practice location

3500 Franciscan Way Ste 400
Michigan City, IN 46360-0021

Mailing address

PO Box 781076
Detroit, MI 48278-1076
Phone (317) 528-4800

Other practice location 1

3500 Franciscan Way STE 400
Michigan City, IN 46360
Phone (219) 878-8200

Other identifiers 1

IdentifierTypeStateIssuer
300026264MedicaidIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190522001701 IN Practitioner - Occupational Therapist in Private Practice 1850634411 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
31006115AINMDOccupational Therapist

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1547596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770940800000",
    "number": "1063986677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 781076",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482781076",
            "telephone_number": "317-528-4800",
            "fax_number": "317-865-1479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 FRANCISCAN WAY STE 400",
            "city": "MICHIGAN CITY",
            "state": "IN",
            "postal_code": "463600021",
            "telephone_number": "219-214-4516",
            "fax_number": "219-861-5725"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3500 Franciscan Way STE 400",
            "address_purpose": "LOCATION",
            "city": "Michigan City",
            "state": "IN",
            "postal_code": "46360",
            "country_code": "US",
            "telephone_number": "219-878-8200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JARVIS",
        "first_name": "THERESA",
        "middle_name": "V",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-16",
        "last_updated": "2026-02-13",
        "certification_date": "2026-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IN",
            "license": "31006115A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300026264",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Michigan City, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2026; 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.