Active NPI
Jennifer Reilly
- Occupational Therapy Assistant
- Longwood, FL
National Provider Identifier
1437564432
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- OTA 12985
- Practice address
- 2639 W State Road 434
Longwood, FL 32779-4878 - Phone
- (321) 972-8326
- NPI assigned
- Jun 27, 2014
- 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 |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | OTA 12985 | FL | Primary |
Addresses
Primary practice location
2639 W State Road 434
Longwood, FL 32779-4878
Mailing address
15 Abacus Ave
Ormond Beach, FL 32174-1047
Phone (386) 871-0428
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 |
|---|---|---|---|
| OTA 12985 | FL | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1403827200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648425600000",
"number": "1437564432",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 ABACUS AVE",
"city": "ORMOND BEACH",
"state": "FL",
"postal_code": "321741047",
"telephone_number": "386-871-0428"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2639 W STATE ROAD 434",
"city": "LONGWOOD",
"state": "FL",
"postal_code": "327794878",
"telephone_number": "321-972-8326"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REILLY",
"first_name": "JENNIFER",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-06-27",
"last_updated": "2022-03-28",
"certification_date": "2022-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "FL",
"license": "OTA 12985",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Longwood, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.