Individual provider Active NPI

Jessica Lazos, COTA/L

  • Occupational Therapy Assistant
  • Clarksville, TN
National Provider Identifier
1508485160
Registry record updated Apr 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
3054 Issued in TN
Practice address
215 Dunbar Cave Rd Ste a
Clarksville, TN 37043-8850
Phone
(931) 542-2739
NPI assigned
Apr 14, 2020
Last updated
Apr 14, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 14, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 224Z00000X 3054 TN Primary

Addresses

Primary practice location

215 Dunbar Cave Rd Ste a
Clarksville, TN 37043-8850

Mailing address

3901 Tyler Brown Dr
Clarksville, TN 37040-2568
Phone (931) 216-1817

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

LicenseStateTypeSpecialty
3054TNMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
More Than Words Speech and Feeding Therapy, LLC Single Specialty CurrentSince Oct 8, 2023 Accepting new patients

Locations

215 Dunbar Cave Rd
Ste A
Clarksville, TN 37043
Phone (800) 920-0834

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, 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": "1586822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586822400000",
    "number": "1508485160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 TYLER BROWN DR",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370402568",
            "telephone_number": "931-216-1817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 DUNBAR CAVE RD STE A",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370438850",
            "telephone_number": "931-542-2739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAZOS",
        "first_name": "JESSICA",
        "credential": "COTA/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-14",
        "last_updated": "2020-04-14",
        "certification_date": "2020-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapy Assistant",
            "state": "TN",
            "license": "3054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.