Active NPI
Jennifer Jo Kennedy, OTRL
- Occupational Therapist
- Buckeye, AZ
National Provider Identifier
1366582314
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 2728
- Practice address
- 25555 W Durango St
Buckeye, AZ 85326-9176 - Phone
- (623) 925-3400
- NPI assigned
- Feb 7, 2007
- Last updated
- Dec 14, 2018
- 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 | 2728 | AZ | Primary |
Addresses
Primary practice location
25555 W Durango St
Buckeye, AZ 85326-9176
Mailing address
25555 W Durango St
Buckeye, AZ 85326-9176
Phone (623) 925-3400
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2728 | Medicaid | AZ | |
| 639940 | Medicaid | AZ |
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 |
|---|---|---|---|
| 2728 | AZ | MD | Occupational Therapist |
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": "1544745600000",
"number": "1366582314",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25555 W DURANGO ST",
"city": "BUCKEYE",
"state": "AZ",
"postal_code": "853269176",
"telephone_number": "623-925-3400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25555 W DURANGO ST",
"city": "BUCKEYE",
"state": "AZ",
"postal_code": "853269176",
"telephone_number": "623-925-3400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "JENNIFER",
"middle_name": "JO",
"name_prefix": "Ms.",
"credential": "OTRL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-07",
"last_updated": "2018-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "AZ",
"license": "2728",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2728",
"state": "AZ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "639940",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Buckeye, AZ
- Taylor Hope Keel, MS
- Madison Christine Kelley, MA
- Corie S Kelly, PA
- Tina Kemmer
- Kennedy Dentistry (Main Street Dental)
- Matthew Kennedy, DDS
- Annette Kerr
- Khakwani and Mohammad Medical PC (PDS Medical Group Victory)
- Khakwani and Mohammad Medical PC (PDS Medical Group Buckeye)
- Khakwani and Mohammad Medical PC (PDS Medical Group Marketplace)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 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.