Active NPI
Diane Marie Jackson, MOT, OTR/L
- Occupational Therapist
- Cedar Rapids, IA
National Provider Identifier
1588212872
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 087310
- Practice address
- 1279 Elmhurst Dr NE
Cedar Rapids, IA 52402-4760 - Phone
- (716) 861-6836
- NPI assigned
- Aug 29, 2019
- Sex
- Female
- Sole proprietor
- No
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 | 087310 | IA | Primary |
Addresses
Primary practice location
1279 Elmhurst Dr NE
Cedar Rapids, IA 52402-4760
Mailing address
1279 Elmhurst Dr NE
Cedar Rapids, IA 52402-4760
Phone (716) 861-6836
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 |
|---|---|---|---|
| 087310 | IA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1567036800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1567036800000",
"number": "1588212872",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1279 ELMHURST DR NE",
"city": "CEDAR RAPIDS",
"state": "IA",
"postal_code": "524024760",
"telephone_number": "716-861-6836"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1279 ELMHURST DR NE",
"city": "CEDAR RAPIDS",
"state": "IA",
"postal_code": "524024760",
"telephone_number": "716-861-6836"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "DIANE",
"middle_name": "MARIE",
"credential": "MOT, OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-08-29",
"last_updated": "2019-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IA",
"license": "087310",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cedar Rapids, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.