Individual provider Active NPI

Jenna Farrelly

  • Occupational Therapist
  • Providence, RI
National Provider Identifier
1326695313
Registry record updated Nov 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OT01793 Issued in RI
Practice address
1000 Eddy St
Providence, RI 02905-4739
Phone
(401) 533-9100
Fax
(401) 533-9105
NPI assigned
Aug 23, 2019
Last updated
Nov 17, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X OT01793 RI Primary

Addresses

Primary practice location

1000 Eddy St
Providence, RI 02905-4739

Mailing address

1000 Eddy St
Providence, RI 02905-4739
Phone (401) 533-9100

Other identifiers 3

IdentifierTypeStateIssuer
SB870OtherRIBC RI
ES01788MedicaidRI
0614OtherRINHP RI

Electronic endpoints 2

TypeEndpointUseAffiliation
Other URL na Other
Other URL na Other

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

LicenseStateTypeSpecialty
OT01793RIMDOccupational Therapist

NPI Registry JSON

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

{
    "created_epoch": "1566518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605571200000",
    "number": "1326695313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 EDDY ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029054739",
            "telephone_number": "401-533-9100",
            "fax_number": "401-533-9105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 EDDY ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029054739",
            "telephone_number": "401-533-9100",
            "fax_number": "401-533-9105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FARRELLY",
        "first_name": "JENNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-23",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "RI",
            "license": "OT01793",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC RI",
            "identifier": "SB870",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ES01788",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NHP RI",
            "identifier": "0614",
            "state": "RI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "na",
            "affiliation": "N",
            "endpointDescription": "na",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "na",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "na",
            "address_1": "1000 Eddy St",
            "city": "Providence",
            "state": "RI",
            "country_code": "US",
            "postal_code": "029054739",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "na",
            "affiliation": "N",
            "endpointDescription": "na",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "na",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "na",
            "address_1": "1000 Eddy St",
            "city": "Providence",
            "state": "RI",
            "country_code": "US",
            "postal_code": "029054739",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2020; 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.