Active NPI
Jessica Lynn Hetman, M.S.ED.
- Occupational Therapy Assistant
- Shirley, NY
National Provider Identifier
1255575353
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 009487
- Practice address
- 42 Tipton Dr W
Shirley, NY 11967-3509 - Phone
- (631) 657-3433
- Fax
- (631) 657-3433
- NPI assigned
- Apr 21, 2009
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | 1759381 | NY | |
| Occupational Therapy Assistant | 224Z00000X | 009487 | NY | Primary |
Addresses
Primary practice location
42 Tipton Dr W
Shirley, NY 11967-3509
Mailing address
42 Tipton Dr W
Shirley, NY 11967-3509
Phone (631) 657-3433
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1759381 | Other | NY | PRE-KINDERGARTEN, KINDERGARTEN & GRADES 1-6, PERMANENT |
| 1759381 | Other | NY | STUDENTS WITH DISABILITIES (B-2) |
| 1759381 | Other | NY | STUDENTS WITH DISABILITIES (1-6) |
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 |
|---|---|---|---|
| 1759381 | NY | MD | Case Manager/Care Coordinator |
| 009487 | NY | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1240272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1505779200000",
"number": "1255575353",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "42 TIPTON DR W",
"city": "SHIRLEY",
"state": "NY",
"postal_code": "119673509",
"telephone_number": "631-657-3433",
"fax_number": "631-657-3433"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "42 TIPTON DR W",
"city": "SHIRLEY",
"state": "NY",
"postal_code": "119673509",
"telephone_number": "631-657-3433",
"fax_number": "631-657-3433"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HETMAN",
"first_name": "JESSICA",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"credential": "M.S.ED.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-04-21",
"last_updated": "2017-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "NY",
"license": "1759381",
"primary": false
},
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "NY",
"license": "009487",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRE-KINDERGARTEN, KINDERGARTEN & GRADES 1-6, PERMANENT",
"identifier": "1759381",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STUDENTS WITH DISABILITIES (B-2)",
"identifier": "1759381",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STUDENTS WITH DISABILITIES (1-6)",
"identifier": "1759381",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shirley, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.