Individual provider Active NPI

Ann Therese Jordan, OTR/L

  • Gerontology Occupational Therapist
  • Encinitas, CA
National Provider Identifier
1265700702
Registry record updated Dec 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Occupational TherapistTaxonomy code 225XG0600X
License
OT 1430 Issued in CA
Practice address
533 2ND St
Encinitas, CA 92024-3558
Phone
(760) 814-4938
Fax
(888) 773-3272
NPI assigned
Dec 12, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 12, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Occupational Therapist 225XG0600X OT 1430 CA Primary

Addresses

Primary practice location

533 2ND St
Encinitas, CA 92024-3558

Mailing address

1908 Country Grove LN
Encinitas, CA 92024-1905
Phone (760) 943-6801

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

LicenseStateTypeSpecialty
1490CAMDAddiction (Substance Use Disorder) Counselor
OT 1430CAMDGerontology Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
In-Home Physical Therapy PC PastSince Nov 1, 2019 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1323648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323648000000",
    "number": "1265700702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1908 COUNTRY GROVE LN",
            "city": "ENCINITAS",
            "state": "CA",
            "postal_code": "920241905",
            "telephone_number": "760-943-6801",
            "fax_number": "760-943-6801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "533 2ND ST",
            "city": "ENCINITAS",
            "state": "CA",
            "postal_code": "920243558",
            "telephone_number": "760-814-4938",
            "fax_number": "888-773-3272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "ANN",
        "middle_name": "THERESE",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-12-12",
        "last_updated": "2011-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XG0600X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Gerontology",
            "state": "CA",
            "license": "OT 1430",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Encinitas, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 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.