Individual provider Active NPI

Jessica McEwan Solis, OTA

  • Occupational Therapy Assistant
  • Garden Grove, CA
National Provider Identifier
1376010116
Registry record updated Dec 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
3272 Issued in CA
Practice address
12900B Garden Grove Blvd Ste 235
Garden Grove, CA 92843-2027
Phone
(714) 750-9700
Fax
(714) 750-9797
NPI assigned
Oct 30, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 3272 CA Primary

Addresses

Primary practice location

12900B Garden Grove Blvd Ste 235
Garden Grove, CA 92843-2027

Mailing address

PO Box 1726
Westminster, CA 92684-1726
Phone (714) 750-9700

Other identifiers 1

IdentifierTypeStateIssuer
3272OtherCAOTA LICENSE

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
3272CAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Kid Fundamentals Therapy Center, Inc. CurrentSince Sep 1, 2021 Accepting new patients
Orange County Speech Services Occupational Therapist Past Accepting new patients

Locations

12900B Garden Grove Blvd
Ste 235
Garden Grove, CA 92843
Phone (714) 750-9700

12900A Garden Grove Blvd
Ste 220
Garden Grove, CA 92843

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1540857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640131200000",
    "number": "1376010116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1726",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926841726",
            "telephone_number": "714-750-9700",
            "fax_number": "714-750-9797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12900B GARDEN GROVE BLVD STE 235",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928432027",
            "telephone_number": "714-750-9700",
            "fax_number": "714-750-9797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOLIS",
        "first_name": "JESSICA",
        "middle_name": "MCEWAN",
        "credential": "OTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-30",
        "last_updated": "2021-12-22",
        "certification_date": "2021-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "CA",
            "license": "3272",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTA LICENSE",
            "identifier": "3272",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden Grove, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2021; 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.