Active NPI
Jacqueline Jensen, OTR L
- Pediatric Occupational Therapist
- Chicago, IL
National Provider Identifier
1457476285
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- 56007801
- Practice address
- 500 W Superior St
#2204
Chicago, IL 60654-8132 - Phone
- (773) 738-6365
- NPI assigned
- Mar 20, 2007
- 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 | 56007801 | IL | Primary |
Addresses
Primary practice location
500 W Superior St
#2204
Chicago, IL 60654-8132
Mailing address
500 W Superior St
#2204
Chicago, IL 60654-8132
Phone (773) 738-6365
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1617235 | Other | IL | BLUE CROSS BLUE SHIELD |
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 |
|---|---|---|---|
| 56007801 | IL | MD | Pediatric Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jja Therapies Inc | Pediatrics | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369094400000",
"number": "1457476285",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 W SUPERIOR ST",
"address_2": "#2204",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606548132",
"telephone_number": "773-738-6365"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 W SUPERIOR ST",
"address_2": "#2204",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606548132",
"telephone_number": "773-738-6365"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENSEN",
"first_name": "JACQUELINE",
"name_prefix": "Ms.",
"credential": "OTR L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-20",
"last_updated": "2013-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "IL",
"license": "56007801",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "1617235",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.