Jennica Nicole Colvin, OTR

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

110631 Issued in TX

Practice address

4415 Rio D Oro
San Antonio, TX 78233-6748

Phone

(210) 651-3339

Fax

(210) 651-3339

NPI assigned

Nov 3, 2009

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

• Jennica Nicole Gardner Former name

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Boerne Speech Therapy LLCGroup PAC ID 5698075323, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jcolvin@triorehab.direct.kno2fy.com

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

• Boerne Speech Therapy, LLC

  • Physical Therapist
  • Boerne, TX
  • NPI 1477938942

  Occupational Therapist

  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1257206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257206400000",
    "number": "1245567882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 SULLIVAN TRL",
            "city": "EASTON",
            "state": "PA",
            "postal_code": "180407958",
            "telephone_number": "610-944-9782",
            "fax_number": "610-438-2024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4415 RIO D ORO",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782336748",
            "telephone_number": "210-651-3339",
            "fax_number": "210-651-3339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLVIN",
        "first_name": "JENNICA",
        "middle_name": "NICOLE",
        "credential": "OTR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-03",
        "last_updated": "2009-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "TX",
            "license": "110631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNICA",
            "last_name": "GARDNER",
            "middle_name": "NICOLE",
            "credential": "OTR",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ida Michelle Colunga, M.S., CCC-SLP
• Nicole Colunga
• Priscilla Rebecca Colunga, FNP
• Judith Colver, PA-C
• April Colvin, LPC
• Patricia F Colvin, OTR
• Kathryn Colwell, DO
• Tanyah Comar, PTA
• Lourdes E. Comas, DMD
• Sally Combest, MD

• Occupational Therapist in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Occupational Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.