Active NPI
Jennifer Herold, OTD, OTR/L
- Occupational Therapist
- Palm Coast, FL
National Provider Identifier
1124841622
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 20139
- Practice address
- 3 Laurel LN
Palm Coast, FL 32137-2632 - Phone
- (440) 479-4308
- NPI assigned
- Nov 4, 2024
- 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 8
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 7593 | OH | |
| Occupational Therapist | 225X00000X | 006805 | GA | |
| Occupational Therapist | 225X00000X | 31006948A | IN | |
| Occupational Therapist | 225X00000X | 5201010301 | MI | |
| Occupational Therapist | 225X00000X | 4354 | SC | |
| Occupational Therapist | 225X00000X | 6315 | TN | |
| Occupational Therapist | 225X00000X | 60881087 | WA | |
| Occupational Therapist | 225X00000X | 20139 | FL | Primary |
Addresses
Primary practice location
3 Laurel LN
Palm Coast, FL 32137-2632
Mailing address
3 Laurel LN
Palm Coast, FL 32137-2632
Phone (440) 479-4308
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 |
|---|---|---|---|
| 6315 | TN | MD | Clinical Social Worker |
| 006805 | GA | MD | Urology Physician |
| 20139 | FL | MD | Occupational Therapist |
| 31006948A | IN | MD | Occupational Therapist |
| 5201010301 | MI | MD | Occupational Therapist |
| 7593 | OH | MD | Occupational Therapist |
| 60881087 | WA | MD | Occupational Therapist |
| 4354 | SC | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1730678400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730678400000",
"number": "1124841622",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 LAUREL LN",
"city": "PALM COAST",
"state": "FL",
"postal_code": "321372632",
"telephone_number": "440-479-4308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 LAUREL LN",
"city": "PALM COAST",
"state": "FL",
"postal_code": "321372632",
"telephone_number": "440-479-4308"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEROLD",
"first_name": "JENNIFER",
"credential": "OTD, OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-11-04",
"last_updated": "2024-11-04",
"certification_date": "2024-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "OH",
"license": "7593",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "GA",
"license": "006805",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IN",
"license": "31006948A",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MI",
"license": "5201010301",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "SC",
"license": "4354",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TN",
"license": "6315",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WA",
"license": "60881087",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "20139",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palm Coast, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.