Active NPI
Jill Dianne Wood, OTR
- Occupational Therapist
- Richardson, TX
National Provider Identifier
1083245260
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 109850
- Practice address
- 1224 Cypress Dr
Richardson, TX 75080-4803 - Phone
- (214) 457-3933
- NPI assigned
- Jan 28, 2020
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 109850 | TX | Primary |
Addresses
Primary practice location
1224 Cypress Dr
Richardson, TX 75080-4803
Mailing address
1224 Cypress Dr
Richardson, TX 75080-4803
Phone (214) 457-3933
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 109850 | Medicaid | TX |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 109850 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1580169600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580169600000",
"number": "1083245260",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1224 CYPRESS DR",
"city": "RICHARDSON",
"state": "TX",
"postal_code": "750804803",
"telephone_number": "214-457-3933"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1224 CYPRESS DR",
"city": "RICHARDSON",
"state": "TX",
"postal_code": "750804803",
"telephone_number": "214-457-3933"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOOD",
"first_name": "JILL",
"middle_name": "DIANNE",
"credential": "OTR",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-01-28",
"last_updated": "2020-01-28",
"certification_date": "2020-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TX",
"license": "109850",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "109850",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Richardson, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.