Jacquelyn Mary Vance, OCCUPATIONAL THERAPI

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

4665 Issued in SC

Practice address

1005 Maple Dr
Mountain View, AR 72560-8999

Phone

(870) 269-2110

Fax

(870) 269-2923

NPI assigned

Dec 13, 2007

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

Other names 1

• Ms. Jacquelyn Mary Bergemann Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1197504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487548800000",
    "number": "1295918159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 314",
            "city": "MOUNTAIN VIEW",
            "state": "AR",
            "postal_code": "725600314",
            "telephone_number": "870-656-4572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 MAPLE DR",
            "city": "MOUNTAIN VIEW",
            "state": "AR",
            "postal_code": "725608999",
            "telephone_number": "870-269-2110",
            "fax_number": "870-269-2923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANCE",
        "first_name": "JACQUELYN",
        "middle_name": "MARY",
        "name_prefix": "Ms.",
        "credential": "OCCUPATIONAL THERAPI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-12-13",
        "last_updated": "2017-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AR",
            "license": "OTR1660",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "SC",
            "license": "4665",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELYN",
            "last_name": "BERGEMANN",
            "middle_name": "MARY",
            "prefix": "MS.",
            "credential": "OCCUPATIONAL THERAPI",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Townsend Healthcare, LLC
• Janet Townsley, OTRL
• Barbara Turner, CMP
• Robert Twilley
• University of Arkansas for Medical Sciences
• Theodore Vann IV
• Constance Vanover, RECOVERY ASSISTANT
• Senthea Vanvleet
• Charles D Varela, M.D.
• Debra S Varela, CRNA

• Occupational Therapist in Mountain View, AR
• Providers in Mountain View, AR by specialty
• Occupational Therapist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 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.

Verify at the official NPI Registry.