Active NPI
Jillian Malouf
- Pediatric Occupational Therapist
- Ketchikan, AK
National Provider Identifier
1609940956
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- 882
- Practice address
- 5193 Borch St N
Ketchikan, AK 99901-9036 - Phone
- (907) 617-0467
- NPI assigned
- Nov 20, 2006
- 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 |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 882 | AK | Primary |
Addresses
Primary practice location
5193 Borch St N
Ketchikan, AK 99901-9036
Mailing address
5193 Borch St N
Ketchikan, AK 99901-9036
Phone (907) 617-0467
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OT5664 | Medicaid | AK |
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 |
|---|---|---|---|
| 882 | AK | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1609940956",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5193 BORCH ST N",
"city": "KETCHIKAN",
"state": "AK",
"postal_code": "999019036",
"telephone_number": "907-617-0467"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5193 BORCH ST N",
"city": "KETCHIKAN",
"state": "AK",
"postal_code": "999019036",
"telephone_number": "907-617-0467"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALOUF",
"first_name": "JILLIAN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "AK",
"license": "882",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "OT5664",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ketchikan, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.