Jennifer Sue Wade, MOT OTR/L

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

056.008757 Issued in IL

Practice address

1101 N 11TH St
Herrin, IL 62948-2847

Phone

(618) 942-2436

NPI assigned

Aug 22, 2009

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1250899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305504000000",
    "number": "1265664361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 N 11TH ST",
            "city": "HERRIN",
            "state": "IL",
            "postal_code": "629482847",
            "telephone_number": "618-942-2436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 N 11TH ST",
            "city": "HERRIN",
            "state": "IL",
            "postal_code": "629482847",
            "telephone_number": "618-942-2436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADE",
        "first_name": "JENNIFER",
        "middle_name": "SUE",
        "name_prefix": "Ms.",
        "credential": "MOT OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-08-22",
        "last_updated": "2011-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056.008757",
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "IL",
            "license": "056.008757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Scot Eric Walker, PHARMD

• Pediatric Occupational Therapist in Herrin, IL
• Providers in Herrin, IL by specialty
• Pediatric Occupational Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.