Individual provider Active NPI

Jessica Nicole Sallaway, COTA

  • Occupational Therapy Assistant
  • Tallahassee, FL
National Provider Identifier
1528776226
Registry record updated Nov 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
OTA18491 Issued in FL
Practice address
1344 Cross Creek Cir
Tallahassee, FL 32301-3728
Phone
(850) 322-8709
NPI assigned
Nov 10, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 10, 2022

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 OTA18491 FL Primary

Addresses

Primary practice location

1344 Cross Creek Cir
Tallahassee, FL 32301-3728

Mailing address

1292 Pond LN
Grand Ridge, FL 32442-4026
Phone (850) 372-7188

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
OTA18491FLMDOccupational Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1668038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668038400000",
    "number": "1528776226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1292 POND LN",
            "city": "GRAND RIDGE",
            "state": "FL",
            "postal_code": "324424026",
            "telephone_number": "850-372-7188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1344 CROSS CREEK CIR",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323013728",
            "telephone_number": "850-322-8709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SALLAWAY",
        "first_name": "JESSICA",
        "middle_name": "NICOLE",
        "credential": "COTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-11-10",
        "last_updated": "2022-11-10",
        "certification_date": "2022-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapy Assistant",
            "state": "FL",
            "license": "OTA18491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2022; 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.