Individual provider Active NPI

Shaina R Brown, OTD, OTR/L

  • Occupational Therapist
  • Jacksonville, FL
National Provider Identifier
1487375069
Registry record updated May 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OT23290 Issued in FL
Practice address
1325 San Marco Blvd Ste 200
Jacksonville, FL 32207-8566
Phone
(904) 858-7045
Fax
(904) 858-7047
NPI assigned
Sep 12, 2022
Last updated
May 9, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X OT23290 FL Primary

Addresses

Primary practice location

1325 San Marco Blvd Ste 200
Jacksonville, FL 32207-8566

Mailing address

PO Box 117345
Atlanta, GA 30368-7345
Phone (904) 346-3465

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240522003000 FL Practitioner - Occupational Therapist in Private Practice 7911349949 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OT23290FLMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Jacksonville Orthopaedic Institute Inc Occupational Therapist CurrentSince Apr 29, 2024 Accepting new patients
Select Physical Therapy Holdings Inc PastSince Sep 1, 2022 Accepting new patients
Jacksonville Orthopaedic Institute Inc Occupational Therapist PastSince Apr 29, 2024 Accepting new patients

Locations

1348 S 18th St
Ste 320A
Fernandina Beach, FL 32034
Phone (904) 557-9021

1325 San Marco Blvd
Ste 102
Jacksonville, FL 32207
Phone (904) 557-9021

1325 San Marco Blvd
Ste 200
Jacksonville, FL 32207
Phone (904) 346-3465

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1662940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715212800000",
    "number": "1487375069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 117345",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303687345",
            "telephone_number": "904-346-3465",
            "fax_number": "904-858-6489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 SAN MARCO BLVD STE 200",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078566",
            "telephone_number": "904-858-7045",
            "fax_number": "904-858-7047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "SHAINA",
        "middle_name": "R",
        "credential": "OTD, OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-12",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "FL",
            "license": "OT23290",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.