Active NPI
Julie Averill, OTR
- Community Health Worker
- San Mateo, CA
National Provider Identifier
1386954246
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 2230
- Practice address
- 208 30TH Ave
San Mateo, CA 94403-2715 - Phone
- (650) 372-9613
- NPI assigned
- Oct 13, 2010
- Last updated
- Oct 13, 2010
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 2230 | CA | Primary |
Addresses
Primary practice location
208 30TH Ave
San Mateo, CA 94403-2715
Mailing address
208 30TH Ave
San Mateo, CA 94403-2715
Phone (650) 372-9613
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 |
|---|---|---|---|
| 2230 | CA | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1286928000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1286928000000",
"number": "1386954246",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "208 30TH AVE",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944032715",
"telephone_number": "650-372-9613"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "208 30TH AVE",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944032715",
"telephone_number": "650-372-9613"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AVERILL",
"first_name": "JULIE",
"credential": "OTR",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-10-13",
"last_updated": "2010-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "CA",
"license": "2230",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Mateo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.