Individual provider Active NPI

Bobby Dan Wesson Jr., COTA

  • Occupational Therapy Assistant
  • Milledgeville, GA
National Provider Identifier
1619008117
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
000282 Issued in GA
Practice address
821 N Cobb St
Milledgeville, GA 31061-2343
Phone
(478) 457-2858
NPI assigned
Mar 8, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 000282 GA Primary

Addresses

Primary practice location

821 N Cobb St
Milledgeville, GA 31061-2343

Mailing address

1061 Plantation Club Cir
Gray, GA 31032-6311
Phone (478) 986-1165

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

LicenseStateTypeSpecialty
000282GAMDOccupational Therapist

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619008117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1061 PLANTATION CLUB CIR",
            "city": "GRAY",
            "state": "GA",
            "postal_code": "310326311",
            "telephone_number": "478-986-1165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "821 N COBB ST",
            "city": "MILLEDGEVILLE",
            "state": "GA",
            "postal_code": "310612343",
            "telephone_number": "478-457-2858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WESSON",
        "first_name": "BOBBY",
        "middle_name": "DAN",
        "name_suffix": "Jr.",
        "credential": "COTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "GA",
            "license": "000282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milledgeville, GA

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.

Verify at the official NPI Registry.