Active NPI
Jennifer Degeyter Wisdom, COTA/L
- Occupational Therapy Assistant
- Breaux Bridge, LA
National Provider Identifier
1144457664
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- Z20509
- Practice address
- 210 Champagne Blvd
Breaux Bridge, LA 70517-3700 - Phone
- (337) 507-1106
- NPI assigned
- Jun 11, 2009
- Sex
- Female
- Sole proprietor
- Yes
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 | Z20509 | LA | Primary |
Addresses
Primary practice location
210 Champagne Blvd
Breaux Bridge, LA 70517-3700
Mailing address
4752 Bridge Street Hwy
St. Martinville, LA 70582
Phone (337) 845-4880
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 |
|---|---|---|---|
| Z20509 | LA | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1244678400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1244678400000",
"number": "1144457664",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4752 BRIDGE STREET HWY",
"city": "ST. MARTINVILLE",
"state": "LA",
"postal_code": "70582",
"telephone_number": "337-845-4880"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 CHAMPAGNE BLVD",
"city": "BREAUX BRIDGE",
"state": "LA",
"postal_code": "705173700",
"telephone_number": "337-507-1106"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISDOM",
"first_name": "JENNIFER",
"middle_name": "DEGEYTER",
"name_prefix": "Mrs.",
"credential": "COTA/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-06-11",
"last_updated": "2009-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "LA",
"license": "Z20509",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Breaux Bridge, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.