Active NPI
Jerry Ennis Jr.
- Occupational Therapist
- Bradenton, FL
National Provider Identifier
1619399482
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT11536
- Practice address
- 6406 21St Ave W
Bradenton, FL 34209-7850 - Phone
- (941) 798-8712
- NPI assigned
- Jan 14, 2014
- Sex
- Male
- 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 | OT11536 | FL | Primary |
Addresses
Primary practice location
6406 21St Ave W
Bradenton, FL 34209-7850
Mailing address
6406 21St Ave W
Bradenton, FL 34209-7850
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT11536 | FL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1389657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389657600000",
"number": "1619399482",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6406 21ST AVE W",
"city": "BRADENTON",
"state": "FL",
"postal_code": "342097850"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6406 21ST AVE W",
"city": "BRADENTON",
"state": "FL",
"postal_code": "342097850",
"telephone_number": "941-798-8712"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENNIS",
"first_name": "JERRY",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-01-14",
"last_updated": "2014-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "OT11536",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bradenton, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.