Active NPI
Shea Jackson, OTR/L
- Occupational Therapist
- Paducah, KY
National Provider Identifier
1255058475
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 280416
- Practice address
- 100 Kiana CT Apt a
Paducah, KY 42001-6767 - Phone
- (270) 443-0681
- NPI assigned
- Oct 27, 2022
- 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 | 280416 | KY | Primary |
Addresses
Primary practice location
100 Kiana CT Apt a
Paducah, KY 42001-6767
Mailing address
100 Kiana CT Apt a
Paducah, KY 42001-6767
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 |
|---|---|---|---|
| 280416 | KY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1666828800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666828800000",
"number": "1255058475",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 KIANA CT APT A",
"city": "PADUCAH",
"state": "KY",
"postal_code": "420016767"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 KIANA CT APT A",
"city": "PADUCAH",
"state": "KY",
"postal_code": "420016767",
"telephone_number": "270-443-0681"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "SHEA",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-10-27",
"last_updated": "2022-10-27",
"certification_date": "2022-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "KY",
"license": "280416",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Paducah, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.