Active NPI
Andrea Jo Dejean, OTR
- Occupational Therapist
- Nacogdoches, TX
National Provider Identifier
1386136372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 117351
- Practice address
- 817 N Mound St
Nacogdoches, TX 75961-4427 - Phone
- (936) 554-0600
- NPI assigned
- Jun 5, 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 | 117351 | TX | Primary |
Addresses
Primary practice location
817 N Mound St
Nacogdoches, TX 75961-4427
Mailing address
817 N Mound St
Nacogdoches, TX 75961-4427
Phone (936) 564-6907
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 |
|---|---|---|---|
| 117351 | TX | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hettie Legg & Associates | Occupational Therapist | 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.
-
- Comprehensive Outpatient Rehabilitation Facility (CORF)
- Nacogdoches, TX
- NPI 1396908232
Occupational Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528156800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588032000000",
"number": "1386136372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "817 N MOUND ST",
"city": "NACOGDOCHES",
"state": "TX",
"postal_code": "759614427",
"telephone_number": "936-564-6907"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "817 N MOUND ST",
"city": "NACOGDOCHES",
"state": "TX",
"postal_code": "759614427",
"telephone_number": "936-554-0600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEJEAN",
"first_name": "ANDREA",
"middle_name": "JO",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-06-05",
"last_updated": "2020-04-28",
"certification_date": "2020-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TX",
"license": "117351",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nacogdoches, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 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.