Active NPI
Carol Ann Avera, MS, OTR/L
- Occupational Therapist
- Pooler, GA
National Provider Identifier
1215214341
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT.4075OT
- Practice address
- 179 Spanton Cres
Pooler, GA 31322-9673 - Phone
- (912) 704-4277
- NPI assigned
- Nov 3, 2011
- Last updated
- Mar 1, 2013
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT005162 | GA | |
| Occupational Therapist | 225X00000X | OT.4075OT | SC | Primary |
Addresses
Primary practice location
179 Spanton Cres
Pooler, GA 31322-9673
Mailing address
179 Spanton Cres
Pooler, GA 31322-9673
Phone (912) 704-4277
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT005162 | GA | MD | Occupational Therapist |
| OT.4075OT | SC | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1320278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1362096000000",
"number": "1215214341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "179 SPANTON CRES",
"city": "POOLER",
"state": "GA",
"postal_code": "313229673",
"telephone_number": "912-704-4277"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "179 SPANTON CRES",
"city": "POOLER",
"state": "GA",
"postal_code": "313229673",
"telephone_number": "912-704-4277"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AVERA",
"first_name": "CAROL",
"middle_name": "ANN",
"credential": "MS, OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-11-03",
"last_updated": "2013-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "GA",
"license": "OT005162",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "SC",
"license": "OT.4075OT",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pooler, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 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.