Jill Wall, M.O.T.R/L

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

7786 Issued in CA

Practice address

205 E State St
Redlands, CA 92373-5232

Phone

(909) 793-1078

Fax

(909) 335-7330

NPI assigned

Nov 26, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1385424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1385424000000",
    "number": "1578993630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34889 GRAPE AVE",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923996012",
            "telephone_number": "909-809-0129",
            "fax_number": "909-793-1078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 E STATE ST",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923735232",
            "telephone_number": "909-793-1078",
            "fax_number": "909-335-7330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "JILL",
        "credential": "M.O.T.R/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-11-26",
        "last_updated": "2013-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "CA",
            "license": "7786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Harris Wailes, DDS
• Wal-Mart Stores, Inc. (Vision Center 30-1693)
• Walgreen Co (Walgreens #07976)
• Rajeev Walia, MD
• Katarzyna Walker
• Marc Wall
• Vanessa Wallace
• James K Wallman, M.D.
• Walmart Inc. (Walmart Pharmacy 10-1693)
• Walter Jones, III, M.D., Inc.

• Pediatric Occupational Therapist in Redlands, CA
• Providers in Redlands, CA by specialty
• Pediatric Occupational Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.