Active NPI
Jordan Herwaldt, OT-A
- Occupational Therapy Assistant
- Siloam Springs, AR
National Provider Identifier
1639478266
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- O-T1078
- Practice address
- 851 S Dogwood St
Siloam Springs, AR 72761-3915 - Phone
- (479) 220-5361
- NPI assigned
- Mar 22, 2011
- 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 Therapy Assistant | 224Z00000X | O-T1078 | AR | Primary |
Addresses
Primary practice location
851 S Dogwood St
Siloam Springs, AR 72761-3915
Mailing address
851 S Dogwood St
Siloam Springs, AR 72761-3915
Phone (479) 220-5361
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| O-T1078 | Other | AR | OT-A LICENSE |
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 |
|---|---|---|---|
| O-T1078 | AR | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1300752000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722211200000",
"number": "1639478266",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "851 S DOGWOOD ST",
"city": "SILOAM SPRINGS",
"state": "AR",
"postal_code": "727613915",
"telephone_number": "479-220-5361"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "851 S DOGWOOD ST",
"city": "SILOAM SPRINGS",
"state": "AR",
"postal_code": "727613915",
"telephone_number": "479-220-5361"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERWALDT",
"first_name": "JORDAN",
"name_prefix": "Mrs.",
"credential": "OT-A",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-03-22",
"last_updated": "2024-07-29",
"certification_date": "2024-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "AR",
"license": "O-T1078",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OT-A LICENSE",
"identifier": "O-T1078",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Siloam Springs, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.