Individual provider Active NPI

Jody Lee Robertson, COTA/L

  • Occupational Therapy Assistant
  • Indian Harbour Beach, FL
National Provider Identifier
1629613013
Registry record updated Nov 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
OTA17461 Issued in FL
Practice address
2040 Highway A1A Ste 203
Indian Harbour Beach, FL 32937-3566
Phone
(321) 773-8989
Fax
(321) 773-7999
NPI assigned
Nov 9, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2019

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 OTA17461 FL Primary

Addresses

Primary practice location

2040 Highway A1A Ste 203
Indian Harbour Beach, FL 32937-3566

Mailing address

1580 Perdido CT
Melbourne, FL 32940-6226
Phone (218) 780-1991

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
OTA17461FLMDOccupational Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1573257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573257600000",
    "number": "1629613013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1580 PERDIDO CT",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329406226",
            "telephone_number": "218-780-1991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2040 HIGHWAY A1A STE 203",
            "city": "INDIAN HARBOUR BEACH",
            "state": "FL",
            "postal_code": "329373566",
            "telephone_number": "321-773-8989",
            "fax_number": "321-773-7999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "JODY",
        "middle_name": "LEE",
        "credential": "COTA/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-09",
        "last_updated": "2019-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "FL",
            "license": "OTA17461",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indian Harbour Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 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.

Verify at the official NPI Registry.