Active NPI
Chante Olivia Jackson, C.O.T.A.L
- Occupational Therapy Assistant
- Southfield, MI
National Provider Identifier
1497523641
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 5202006981
- Practice address
- 16112 Mount Vernon St
Southfield, MI 48075-3188 - Phone
- (313) 617-8398
- NPI assigned
- Dec 18, 2023
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 5202006981 | MI | |
| Occupational Therapy Assistant | 224Z00000X | 5202006981 | MI | Primary |
Addresses
Primary practice location
16112 Mount Vernon St
Southfield, MI 48075-3188
Mailing address
25330 W 6 Mile Rd
Redford, MI 48240-2105
Phone (313) 531-6874
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | 2051 | Other |
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 |
|---|---|---|---|
| 5202006981 | MI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1702857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1702857600000",
"number": "1497523641",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25330 W 6 MILE RD",
"city": "REDFORD",
"state": "MI",
"postal_code": "482402105",
"telephone_number": "313-531-6874"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16112 MOUNT VERNON ST",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480753188",
"telephone_number": "313-617-8398"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "CHANTE",
"middle_name": "OLIVIA",
"name_prefix": "Mrs.",
"credential": "C.O.T.A.L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-12-18",
"last_updated": "2023-12-18",
"certification_date": "2021-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MI",
"license": "5202006981",
"primary": false
},
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "MI",
"license": "5202006981",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "2051",
"affiliation": "N",
"endpointDescription": "other",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "2051",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "2051",
"address_1": "16112 Mount Vernon St",
"city": "Southfield",
"state": "MI",
"country_code": "US",
"postal_code": "480753188",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.