Jean Marie Wannall, OTR/L, OTD

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

006296 Issued in NY

Practice address

205 Clark Street Ext
Groton, NY 13073-9401

Phone

(607) 898-4282

NPI assigned

Sep 15, 2015

Last updated

Sep 15, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1442275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442275200000",
    "number": "1285003764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 CLARK STREET EXT",
            "city": "GROTON",
            "state": "NY",
            "postal_code": "130739401",
            "telephone_number": "607-898-4282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 CLARK STREET EXT",
            "city": "GROTON",
            "state": "NY",
            "postal_code": "130739401",
            "telephone_number": "607-898-4282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANNALL",
        "first_name": "JEAN",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "OTR/L, OTD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-09-15",
        "last_updated": "2015-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NY",
            "license": "006296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in Groton, NY
• Providers in Groton, NY by specialty
• Occupational Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2015; 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.