Jeanine Patricia Davis, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

32000437A Issued in IN

Practice address

2350 Taft St
Gary, IN 46404-3349

Phone

(219) 977-2600

NPI assigned

Jan 26, 2012

Last updated

Jan 26, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Jeanine Patricia Portlock Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Infinite Medical PC

  • Family Medicine Physician
  • Bristol, RI
  • NPI 1407483175
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1327536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327536000000",
    "number": "1164794897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5299 LYNDELL AVE",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463681847",
            "telephone_number": "219-763-6504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2350 TAFT ST",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464043349",
            "telephone_number": "219-977-2600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "JEANINE",
        "middle_name": "PATRICIA",
        "name_prefix": "Mrs.",
        "credential": "COTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-26",
        "last_updated": "2012-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "IN",
            "license": "32000437A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEANINE",
            "last_name": "PORTLOCK",
            "middle_name": "PATRICIA",
            "prefix": "MRS.",
            "credential": "COTA",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Zeno Darden Jr.
• Dawn Davenport
• David E Ross, Jr, MD,PC (Primary Care Consultants)
• Herbert Davis
• Jaunesia Davis
• Mary Davis
• Stephanie Davis, MPA
• Debbie's Promise Care
• Amanda Joy Dech, MSN/FNP-C
• Kathryn Demitroulas

• Occupational Therapy Assistant in Gary, IN
• Providers in Gary, IN by specialty
• Occupational Therapy Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.