Active NPI
Michael Jackson, COTA
- Occupational Therapy Assistant
- Tacoma, WA
National Provider Identifier
1467823104
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- OC 60534324
- Practice address
- 1913 N Oakes St Apt D
Tacoma, WA 98406-7527 - Phone
- (253) 223-3590
- NPI assigned
- Oct 7, 2015
- Sex
- Male
- 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 | OC 60534324 | WA | Primary |
Addresses
Primary practice location
1913 N Oakes St Apt D
Tacoma, WA 98406-7527
Mailing address
1913 N Oakes St Apt D
Tacoma, WA 98406-7527
Phone (253) 223-3590
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 |
|---|---|---|---|
| OC 60534324 | WA | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1444176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1444176000000",
"number": "1467823104",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1913 N OAKES ST APT D",
"city": "TACOMA",
"state": "WA",
"postal_code": "984067527",
"telephone_number": "253-223-3590"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1913 N OAKES ST APT D",
"city": "TACOMA",
"state": "WA",
"postal_code": "984067527",
"telephone_number": "253-223-3590"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MICHAEL",
"name_prefix": "Mr.",
"credential": "COTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-10-07",
"last_updated": "2015-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "WA",
"license": "OC 60534324",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.