Active NPI
Jacob Brannon Ellis
- Occupational Therapy Assistant
- Madison, AL
National Provider Identifier
1306358270
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 4316
- Practice address
- 97 Hughes Rd Ste H
Madison, AL 35758-3401 - Phone
- (256) 883-7338
- Fax
- (256) 883-7135
- NPI assigned
- Oct 31, 2017
- Sex
- Male
- Sole proprietor
- Yes
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 Therapy Assistant | 224Z00000X | 4316 | AL | Primary |
Addresses
Primary practice location
97 Hughes Rd Ste H
Madison, AL 35758-3401
Mailing address
97 Hughes Rd Ste H
Madison, AL 35758-3401
Phone (256) 883-7338
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 |
|---|---|---|---|
| 4316 | AL | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Therapy Link of North Alabama, LLC | Past | 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.
-
- Rehabilitation Clinic/Center
- Madison, AL
- NPI 1447448550
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1509408000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1509408000000",
"number": "1306358270",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "97 HUGHES RD STE H",
"city": "MADISON",
"state": "AL",
"postal_code": "357583401",
"telephone_number": "256-883-7338",
"fax_number": "256-883-7135"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "97 HUGHES RD STE H",
"city": "MADISON",
"state": "AL",
"postal_code": "357583401",
"telephone_number": "256-883-7338",
"fax_number": "256-883-7135"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "JACOB",
"middle_name": "BRANNON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-10-31",
"last_updated": "2017-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Occupational Therapy Assistant",
"state": "AL",
"license": "4316",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 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.