Active NPI
Jennifer Bayron, OTR
- Occupational Therapist
- Lake Wales, FL
National Provider Identifier
1336289750
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT5188
- Practice address
- 501 Burns Ave
Lake Wales, FL 33853-3335 - Phone
- (863) 679-3338
- NPI assigned
- Feb 7, 2007
- Last updated
- Nov 6, 2020
- Sex
- Female
- 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 | 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 89059106 | Medicaid | FL |
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 |
|---|---|---|---|
| OT5188 | FL | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Victory Ridge Academy, Inc. | Occupational Therapist | Current | 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.