Active NPI
Jessica Keely Wahl, OT
- Children's Rehabilitation Hospital
- Bountiful, UT
National Provider Identifier
1093165599
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Children's Rehabilitation Hospital
- License
- 9819390-4201
- Practice address
- 280 N Main St
Bountiful, UT 84010-6136 - Phone
- (016) 624-9498
- NPI assigned
- Jun 15, 2016
- 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 |
|---|---|---|---|---|
| Children's Rehabilitation Hospital | 283XC2000X | 9819390-4201 | UT | Primary |
Addresses
Primary practice location
280 N Main St
Bountiful, UT 84010-6136
Mailing address
PO Box 30180
Salt Lake City, UT 84130-0180
Other practice location 1
100 N Mario Capecchi Dr
Slc, UT 84113-1103
Phone (801) 662-4980
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Bluemark LLC/ Office Ally |
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 |
|---|---|---|---|
| 9819390-4201 | UT | MD | Children's Rehabilitation Hospital |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1465948800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1769644800000",
"number": "1093165599",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 30180",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841300180"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "280 N MAIN ST",
"city": "BOUNTIFUL",
"state": "UT",
"postal_code": "840106136",
"telephone_number": "016-624-9498"
}
],
"practiceLocations": [
{
"address_1": "100 N Mario Capecchi Dr",
"address_purpose": "LOCATION",
"city": "Slc",
"state": "UT",
"postal_code": "841131103",
"country_code": "US",
"telephone_number": "801-662-4980",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WAHL",
"first_name": "JESSICA",
"middle_name": "KEELY",
"name_prefix": "Mrs.",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-06-15",
"last_updated": "2026-01-29",
"certification_date": "2026-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "283XC2000X",
"taxonomy_group": "",
"desc": "Rehabilitation Hospital, Children",
"state": "UT",
"license": "9819390-4201",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
"affiliation": "Y",
"endpointDescription": "2.16.840.1.113883.3.2019.3",
"affiliationName": "Bluemark LLC/ Office Ally",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CMS esMD eMDR",
"address_1": "1300 SE Cardinal Ct Ste 190",
"city": "Vancouver",
"state": "WA",
"country_code": "US",
"postal_code": "986839683",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Bountiful, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.