Individual provider Active NPI

Jennifer Bayron, OTR

  • Occupational Therapist
  • Lake Wales, FL
National Provider Identifier
1336289750
Registry record updated Nov 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OT5188 Issued in FL
Practice address
501 Burns Ave
Lake Wales, FL 33853-3335
Phone
(863) 679-3338
NPI assigned
Feb 7, 2007
Last updated
Nov 6, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 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 OT5188 FL Primary

Addresses

Primary practice location

501 Burns Ave
Lake Wales, FL 33853-3335

Mailing address

2403 E Henry Ave
Tampa, FL 33610-4434
Phone (813) 988-7633

Other identifiers 1

IdentifierTypeStateIssuer
89059106MedicaidFL

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
OT5188FLMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Victory Ridge Academy, Inc. Occupational Therapist CurrentSince Nov 8, 2020 Accepting new patients

Locations

501 Burns Ave
Lake Wales, FL 33853
Phone (863) 679-3338

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604620800000",
    "number": "1336289750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2403 E HENRY AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336104434",
            "telephone_number": "813-988-7633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 BURNS AVE",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338533335",
            "telephone_number": "863-679-3338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAYRON",
        "first_name": "JENNIFER",
        "credential": "OTR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-07",
        "last_updated": "2020-11-06",
        "certification_date": "2020-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "FL",
            "license": "OT5188",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89059106",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Wales, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 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.