Active NPI
Idoll Tina Jackson, COTA
- Occupational Therapy Assistant
- Tyler, TX
National Provider Identifier
1427530641
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 209095
- Practice address
- 2650 Elkton TRL
Tyler, TX 75703-0580 - Phone
- (903) 266-7200
- NPI assigned
- Sep 4, 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 Therapy Assistant | 224Z00000X | 209095 | TX | Primary |
Addresses
Primary practice location
2650 Elkton TRL
Tyler, TX 75703-0580
Mailing address
250 W Nottingham Dr Ste 200
San Antonio, TX 78209-1896
Phone (210) 828-5686
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 |
|---|---|---|---|
| 209095 | TX | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1536019200000",
"number": "1427530641",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 W NOTTINGHAM DR STE 200",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782091896",
"telephone_number": "210-828-5686",
"fax_number": "210-780-6911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2650 ELKTON TRL",
"city": "TYLER",
"state": "TX",
"postal_code": "757030580",
"telephone_number": "903-266-7200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "IDOLL",
"middle_name": "TINA",
"name_prefix": "Mrs.",
"credential": "COTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-09-04",
"last_updated": "2018-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "TX",
"license": "209095",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 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.