Active NPI
Jacqueline Golden Wilson, OTR
- Occupational Therapist
- Upperco, MD
National Provider Identifier
1225244692
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 01516
- Practice address
- 15115 Eastview Dr
Upperco, MD 21155-9746 - Phone
- (410) 429-1906
- Fax
- (410) 429-1906
- NPI assigned
- May 15, 2007
- Last updated
- Jul 9, 2007
- 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 Therapist | 225X00000X | 01516 | MD | Primary |
Addresses
Primary practice location
15115 Eastview Dr
Upperco, MD 21155-9746
Mailing address
15115 Eastview Dr
Upperco, MD 21155-9746
Phone (410) 429-1906
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01516 | MD | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northwest O.T. Associates, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Rehabilitation Clinic/Center
- Upperco, MD
- NPI 1134310238
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1225244692",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15115 EASTVIEW DR",
"city": "UPPERCO",
"state": "MD",
"postal_code": "211559746",
"telephone_number": "410-429-1906",
"fax_number": "410-429-1906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15115 EASTVIEW DR",
"city": "UPPERCO",
"state": "MD",
"postal_code": "211559746",
"telephone_number": "410-429-1906",
"fax_number": "410-429-1906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JACQUELINE",
"middle_name": "GOLDEN",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-15",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MD",
"license": "01516",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Upperco, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.