Jennifer M Speer, RECREATION THERAPIST

Primary specialty

Recreation TherapistTaxonomy code 225800000X

License

1102 Issued in NC

Practice address

1011 Breakmaker LN
Indian Trail, NC 28079-5559

Phone

(980) 585-8552

NPI assigned

Mar 30, 2007

Last updated

Oct 26, 2020By 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

• Jennifer Moore Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603670400000",
    "number": "1225158389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 BREAKMAKER LN",
            "city": "INDIAN TRAIL",
            "state": "NC",
            "postal_code": "280795559",
            "telephone_number": "980-585-8552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 BREAKMAKER LN",
            "city": "INDIAN TRAIL",
            "state": "NC",
            "postal_code": "280795559",
            "telephone_number": "980-585-8552"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 Blythe Blvd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282035814",
            "country_code": "US",
            "telephone_number": "704-355-8484",
            "fax_number": "704-355-4231",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SPEER",
        "first_name": "JENNIFER",
        "middle_name": "M",
        "credential": "RECREATION THERAPIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-30",
        "last_updated": "2020-10-26",
        "certification_date": "2020-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225800000X",
            "taxonomy_group": "",
            "desc": "Recreation Therapist",
            "state": "NC",
            "license": "1102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "MOORE",
            "credential": "RECREATION THERAPIST",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Recreation Therapist in Indian Trail, NC
• Providers in Indian Trail, NC by specialty
• Recreation Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 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.