Active NPI
Christian Jackson
- Occupational Therapist
- Burley, ID
National Provider Identifier
1326455874
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT-1334
- Practice address
- 1501 Hiland Ave
Burley, ID 83318-2688 - Phone
- (208) 677-6530
- NPI assigned
- Jul 16, 2014
- Sex
- Male
- 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 | OT-1334 | ID | Primary |
Addresses
Primary practice location
1501 Hiland Ave
Burley, ID 83318-2688
Mailing address
1501 Hiland Ave
Burley, ID 83318-2688
Phone (208) 677-6530
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 |
|---|---|---|---|
| OT-1334 | ID | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405468800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675382400000",
"number": "1326455874",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1501 HILAND AVE",
"city": "BURLEY",
"state": "ID",
"postal_code": "833182688",
"telephone_number": "208-677-6530"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 HILAND AVE",
"city": "BURLEY",
"state": "ID",
"postal_code": "833182688",
"telephone_number": "208-677-6530"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "CHRISTIAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-07-16",
"last_updated": "2023-02-03",
"certification_date": "2023-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "ID",
"license": "OT-1334",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burley, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.