Active NPI
Jacob Palmer Adams, MSOTR/L
- Occupational Therapist
- Vincennes, IN
National Provider Identifier
1104330679
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 17203
- Practice address
- 2860 E State Road 61
Vincennes, IN 47591-9056 - Phone
- (812) 887-1219
- NPI assigned
- Nov 20, 2017
- Last updated
- Nov 20, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 5036 | TN | |
| Occupational Therapist | 225X00000X | 17203 | CA | Primary |
Addresses
Primary practice location
2860 E State Road 61
Vincennes, IN 47591-9056
Mailing address
2860 E State Road 61
Vincennes, IN 47591-9056
Phone (812) 887-1219
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 |
|---|---|---|---|
| 17203 | CA | MD | Mental Health Counselor |
| 5036 | TN | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1511136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1511136000000",
"number": "1104330679",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2860 E STATE ROAD 61",
"city": "VINCENNES",
"state": "IN",
"postal_code": "475919056",
"telephone_number": "812-887-1219"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2860 E STATE ROAD 61",
"city": "VINCENNES",
"state": "IN",
"postal_code": "475919056",
"telephone_number": "812-887-1219"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ADAMS",
"first_name": "JACOB",
"middle_name": "PALMER",
"name_prefix": "Mr.",
"credential": "MSOTR/L",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-11-20",
"last_updated": "2017-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TN",
"license": "5036",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "17203",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vincennes, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.