Active NPI
Jennifer K Gragg, MOTR/L
- Occupational Therapist
- Albuquerque, NM
National Provider Identifier
1558018804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT4630
- Practice address
- 1501 San Pedro Dr SE
Albuquerque, NM 87108-5153 - Phone
- (505) 265-1711
- NPI assigned
- Mar 7, 2022
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT4630 | NM | Primary |
Addresses
Primary practice location
1501 San Pedro Dr SE
Albuquerque, NM 87108-5153
Mailing address
7 Prairie Hawk Dr
Los Lunas, NM 87031-7177
Phone (575) 915-6154
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 |
|---|---|---|---|
| OT4630 | NM | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1646611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1646611200000",
"number": "1558018804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7 PRAIRIE HAWK DR",
"city": "LOS LUNAS",
"state": "NM",
"postal_code": "870317177",
"telephone_number": "575-915-6154"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 SAN PEDRO DR SE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871085153",
"telephone_number": "505-265-1711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAGG",
"first_name": "JENNIFER",
"middle_name": "K",
"credential": "MOTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-03-07",
"last_updated": "2022-03-07",
"certification_date": "2021-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NM",
"license": "OT4630",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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.