Active NPI
Sara W. Jackson, OTR/L
- Occupational Therapist
- Richmond, VA
National Provider Identifier
1114366945
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 0119001407
- Practice address
- 1201 Broad Rock Blvd
PM&R/117
Richmond, VA 23249-0001 - Phone
- (804) 675-5000
- NPI assigned
- Jun 14, 2013
- 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 | 0119001407 | VA | Primary |
Addresses
Primary practice location
1201 Broad Rock Blvd
PM&R/117
Richmond, VA 23249-0001
Mailing address
1201 Broad Rock Blvd
PM&R/117
Richmond, VA 23249-0001
Phone (804) 675-5000
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 997859 | Other | NATIONAL BOARD FOR CERTIFICATION OF OCCUOPATIONAL THERAPY CERTIFICATION NUMBER | |
| 0119001407 | Other | VA | COMMONWEALTH OF VIRGINIA DEPT OF HEALTH PROFESSIONS LICENSE NUMBER |
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 |
|---|---|---|---|
| 0119001407 | VA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1371168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1371168000000",
"number": "1114366945",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1201 BROAD ROCK BLVD",
"address_2": "PM&R/117",
"city": "RICHMOND",
"state": "VA",
"postal_code": "232490001",
"telephone_number": "804-675-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1201 BROAD ROCK BLVD",
"address_2": "PM&R/117",
"city": "RICHMOND",
"state": "VA",
"postal_code": "232490001",
"telephone_number": "804-675-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "SARA",
"middle_name": "W.",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-06-14",
"last_updated": "2013-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "VA",
"license": "0119001407",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATIONAL BOARD FOR CERTIFICATION OF OCCUOPATIONAL THERAPY CERTIFICATION NUMBER",
"identifier": "997859",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMMONWEALTH OF VIRGINIA DEPT OF HEALTH PROFESSIONS LICENSE NUMBER",
"identifier": "0119001407",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Richmond, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.