Active NPI
Jaymie Claire Clack, OTRL
- Occupational Therapist
- Houston, TX
National Provider Identifier
1083682736
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 110009
- Practice address
- 11811 FM 1960 West
Suite 102
Houston, TX 77065 - Phone
- (281) 469-8163
- Fax
- (281) 469-5559
- NPI assigned
- Mar 9, 2006
- 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 | 110009 | TX | Primary |
Addresses
Primary practice location
11811 FM 1960 West
Suite 102
Houston, TX 77065
Mailing address
12619 Laurel Meadow Way
Houston, TX 77014
Phone (281) 893-4076
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8T1955 | Other | TX | BLUE CROSS BLUE SHIELD |
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 |
|---|---|---|---|
| 110009 | TX | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elevate Physical Therapy and Wellness | Past | Accepting new patients | |
| Star Therapy Centers Limited Partnership | Past | Accepting new patients |
Organizations & group practices 2
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.
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- Durable Medical Equipment & Medical Supplies
- Houston, TX
- NPI 1235371014
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1195603200000",
"number": "1083682736",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12619 LAUREL MEADOW WAY",
"city": "HOUSTON",
"state": "TX",
"postal_code": "77014",
"telephone_number": "281-893-4076",
"fax_number": "281-469-5559"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11811 FM 1960 WEST",
"address_2": "SUITE 102",
"city": "HOUSTON",
"state": "TX",
"postal_code": "77065",
"telephone_number": "281-469-8163",
"fax_number": "281-469-5559"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLACK",
"first_name": "JAYMIE",
"middle_name": "CLAIRE",
"name_prefix": "Mrs.",
"credential": "OTRL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-09",
"last_updated": "2007-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TX",
"license": "110009",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "8T1955",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.