Active NPI
Jewellyn Davin Latham, OTR
- Pediatric Occupational Therapist
- Garland, TX
National Provider Identifier
1376824797
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- 111120
- Practice address
- 2625 Anita Dr.
Garland, TX 75041 - Phone
- (972) 490-9055
- Fax
- (972) 265-0392
- NPI assigned
- Aug 30, 2011
- 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 |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 111120 | TX | Primary |
Addresses
Primary practice location
2625 Anita Dr.
Garland, TX 75041
Mailing address
320 Custer Road
Richardson, TX 75080
Phone (972) 490-9055
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 |
|---|---|---|---|
| 111120 | TX | MD | Pediatric Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Warren Center, Inc | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Multi-Specialty Clinic/Center
- Richardson, TX
- NPI 1538214200
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314662400000",
"number": "1376824797",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "320 CUSTER ROAD",
"city": "RICHARDSON",
"state": "TX",
"postal_code": "75080",
"telephone_number": "972-490-9055",
"fax_number": "972-265-0392"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2625 ANITA DR.",
"city": "GARLAND",
"state": "TX",
"postal_code": "75041",
"telephone_number": "972-490-9055",
"fax_number": "972-265-0392"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LATHAM",
"first_name": "JEWELLYN",
"middle_name": "DAVIN",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-08-30",
"last_updated": "2011-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "TX",
"license": "111120",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Garland, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.