Active NPI
Jennifer J Wallace, COTA/L
- Occupational Therapy Assistant
- McAlester, OK
National Provider Identifier
1114150604
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 632
- Practice address
- 101 Oklahoma Ave
McAlester, OK 74501-7520 - Phone
- (580) 298-9818
- Fax
- (580) 298-9822
- NPI assigned
- Aug 31, 2009
- 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 Therapy Assistant | 224Z00000X | 632 | OK | Primary |
Addresses
Primary practice location
101 Oklahoma Ave
McAlester, OK 74501-7520
Mailing address
101 Oklahoma
McAlester, OK 74501-7520
Phone (918) 421-3935
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 |
|---|---|---|---|
| 632 | OK | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ergonomic Consultants, LLC | Past | Accepting new patients |
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.
-
- Multi-Specialty Clinic/Center
- McAlester, OK
- NPI 1922039882
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1251676800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616630400000",
"number": "1114150604",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 OKLAHOMA",
"city": "MCALESTER",
"state": "OK",
"postal_code": "745017520",
"telephone_number": "918-421-3935",
"fax_number": "918-421-3939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 OKLAHOMA AVE",
"city": "MCALESTER",
"state": "OK",
"postal_code": "745017520",
"telephone_number": "580-298-9818",
"fax_number": "580-298-9822"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "JENNIFER",
"middle_name": "J",
"credential": "COTA/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-08-31",
"last_updated": "2021-03-25",
"certification_date": "2021-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "OK",
"license": "632",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McAlester, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.