Active NPI
Jessica Revells, COTA/L
- Occupational Therapy Assistant
- Fairbanks, AK
National Provider Identifier
1144669052
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 2019
- Practice address
- 734 Manchester Loop
Fairbanks, AK 99712-1120 - Phone
- (907) 388-4426
- NPI assigned
- Jun 25, 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 Therapy Assistant | 224Z00000X | 2019 | AK | Primary |
Addresses
Primary practice location
734 Manchester Loop
Fairbanks, AK 99712-1120
Mailing address
734 Manchester Loop
Fairbanks, AK 99712-1120
Phone (907) 388-4426
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2019 | Other | AK | STATE PHYSICAL THERAPY AND OCCUPATIONAL THERAPY BOARD COTA |
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 |
|---|---|---|---|
| 2019 | AK | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1372118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1372118400000",
"number": "1144669052",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "734 MANCHESTER LOOP",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997121120",
"telephone_number": "907-388-4426"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "734 MANCHESTER LOOP",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997121120",
"telephone_number": "907-388-4426"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REVELLS",
"first_name": "JESSICA",
"credential": "COTA/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-06-25",
"last_updated": "2013-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "AK",
"license": "2019",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE PHYSICAL THERAPY AND OCCUPATIONAL THERAPY BOARD COTA",
"identifier": "2019",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairbanks, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 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.