Jennifer Rebecca Evans, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

056006313 Issued in IL

Practice address

623 Hamacher St
Waterloo, IL 62298-1786

Phone

(618) 939-0400

Fax

(618) 939-0253

NPI assigned

Sep 17, 2020

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

• Mrs. Jennifer R Goodman Former name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 17, 2020.

{
    "created_epoch": "1600300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600300800000",
    "number": "1194331967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1317 SIMMONS RD",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622696607",
            "telephone_number": "618-401-9631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "623 HAMACHER ST",
            "city": "WATERLOO",
            "state": "IL",
            "postal_code": "622981786",
            "telephone_number": "618-939-0400",
            "fax_number": "618-939-0253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "JENNIFER",
        "middle_name": "REBECCA",
        "name_prefix": "Mrs.",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-17",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056006313",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "jevans1@symbria.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "address_1": "623 Hamacher St",
            "city": "Waterloo",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622981786",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "GOODMAN",
            "middle_name": "R",
            "prefix": "MRS.",
            "credential": "OTR/L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• All providers in Waterloo, IL
• Occupational Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2020; 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.