Active NPI
Jessica Revels
- Occupational Therapy Assistant
- Arcadia, LA
National Provider Identifier
1316434004
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- OTA.200028
- Practice address
- 1355 6TH St
Arcadia, LA 71001-3109 - Phone
- (318) 263-9581
- NPI assigned
- Apr 18, 2018
- Last updated
- Apr 18, 2018
- Sex
- Female
- 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 | OTA.200028 | LA | Primary |
Addresses
Primary practice location
1355 6TH St
Arcadia, LA 71001-3109
Mailing address
4109 Highway 98 W
Summit, MS 39666-9132
Phone (601) 276-3909
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 |
|---|---|---|---|
| OTA.200028 | LA | MD | Occupational Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Leslie Lakes Care Center, LLC | Past | Accepting new patients | |
| Health Express Inc | Single Specialty | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Leslie Lakes Retirement Center
- Skilled Nursing Facility
- Arcadia, LA
- NPI 1962411355
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1524009600000",
"number": "1316434004",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4109 HIGHWAY 98 W",
"city": "SUMMIT",
"state": "MS",
"postal_code": "396669132",
"telephone_number": "601-276-3909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1355 6TH ST",
"city": "ARCADIA",
"state": "LA",
"postal_code": "710013109",
"telephone_number": "318-263-9581"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REVELS",
"first_name": "JESSICA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-04-18",
"last_updated": "2018-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Occupational Therapy Assistant",
"state": "LA",
"license": "OTA.200028",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Arcadia, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.