Active NPI
Jessica Elaine Umholtz, COTA
- Occupational Therapy Assistant
- West Lafayette, IN
National Provider Identifier
1245888486
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 32003104A
- Practice address
- 307 Sagamore Pkwy W
West Lafayette, IN 47906-1500 - Phone
- (765) 463-2200
- Fax
- (765) 463-3625
- NPI assigned
- Aug 30, 2019
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 32003104A | IN | Primary |
Addresses
Primary practice location
307 Sagamore Pkwy W
West Lafayette, IN 47906-1500
Mailing address
PO Box 4699
Lafayette, IN 47903-4699
Phone (765) 449-2732
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32003104A | IN | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1567123200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631491200000",
"number": "1245888486",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4699",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479034699",
"telephone_number": "765-449-2732"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "307 SAGAMORE PKWY W",
"city": "WEST LAFAYETTE",
"state": "IN",
"postal_code": "479061500",
"telephone_number": "765-463-2200",
"fax_number": "765-463-3625"
}
],
"practiceLocations": [],
"basic": {
"last_name": "UMHOLTZ",
"first_name": "JESSICA",
"middle_name": "ELAINE",
"credential": "COTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-08-30",
"last_updated": "2021-09-13",
"certification_date": "2021-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Occupational Therapy Assistant",
"state": "IN",
"license": "32003104A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Lafayette, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.