Active NPI
Aesa Jackson, OTR
- Occupational Therapist
- Milwaukie, OR
National Provider Identifier
1306033048
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 0801
- Practice address
- 4560 SE International Way
Suite 100 Consonus Healthcare Services
Milwaukie, OR 97222 - Phone
- (971) 206-5149
- Fax
- (971) 206-5209
- NPI assigned
- Sep 26, 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 | 0801 | NV | Primary |
Addresses
Primary practice location
4560 SE International Way
Suite 100 Consonus Healthcare Services
Milwaukie, OR 97222
Mailing address
4560 SE International Way
Suite 100 Consonus Healthcare Services
Milwaukie, OR 97222
Phone (971) 206-5149
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 |
|---|---|---|---|
| 0801 | NV | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190764800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190764800000",
"number": "1306033048",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4560 SE INTERNATIONAL WAY",
"address_2": "SUITE 100 CONSONUS HEALTHCARE SERVICES",
"city": "MILWAUKIE",
"state": "OR",
"postal_code": "97222",
"telephone_number": "971-206-5149",
"fax_number": "971-206-5209"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4560 SE INTERNATIONAL WAY",
"address_2": "SUITE 100 CONSONUS HEALTHCARE SERVICES",
"city": "MILWAUKIE",
"state": "OR",
"postal_code": "97222",
"telephone_number": "971-206-5149",
"fax_number": "971-206-5209"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "AESA",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-09-26",
"last_updated": "2007-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NV",
"license": "0801",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milwaukie, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 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.