Active NPI
Jennifer Jaetzold
- Occupational Therapist
- Fort Worth, TX
National Provider Identifier
1285768895
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 111158
- Practice address
- 508 S Adams St
Suite 102
Fort Worth, TX 76104-2147 - Phone
- (817) 878-2834
- NPI assigned
- Mar 15, 2007
- 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 | 111158 | TX | Primary |
Addresses
Primary practice location
508 S Adams St
Suite 102
Fort Worth, TX 76104-2147
Mailing address
8430 Brittania Way
Dallas, TX 75243-8026
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 |
|---|---|---|---|
| 111158 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1285768895",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8430 BRITTANIA WAY",
"city": "DALLAS",
"state": "TX",
"postal_code": "752438026"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "508 S ADAMS ST",
"address_2": "SUITE 102",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761042147",
"telephone_number": "817-878-2834"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAETZOLD",
"first_name": "JENNIFER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TX",
"license": "111158",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.