Active NPI
Jaclyn Christofferson
- Occupational Therapist
- Advance, NC
National Provider Identifier
1578831020
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 6893
- Practice address
- 142 Bermuda Village Dr
Advance, NC 27006-7867 - Phone
- (336) 940-3557
- Fax
- (336) 940-3557
- NPI assigned
- Dec 12, 2011
- 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 | 6893 | NC | Primary |
Addresses
Primary practice location
142 Bermuda Village Dr
Advance, NC 27006-7867
Mailing address
430 Willow Ridge LN
Winston Salem, NC 27127-9239
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 |
|---|---|---|---|
| 6893 | NC | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1520294400000",
"number": "1578831020",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "430 WILLOW RIDGE LN",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271279239"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "142 BERMUDA VILLAGE DR",
"city": "ADVANCE",
"state": "NC",
"postal_code": "270067867",
"telephone_number": "336-940-3557",
"fax_number": "336-940-3557"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHRISTOFFERSON",
"first_name": "JACLYN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-12-12",
"last_updated": "2018-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NC",
"license": "6893",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Advance, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.