Active NPI
Kristan Jackson, MS OTR/L
- Occupational Therapist
- Chicago, IL
National Provider Identifier
1639593148
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 056010441
- Practice address
- 520 W Huron St
Apt 207
Chicago, IL 60654-3432 - Phone
- (804) 814-3104
- NPI assigned
- Feb 5, 2014
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 056010441 | IL | Primary |
Addresses
Primary practice location
520 W Huron St
Apt 207
Chicago, IL 60654-3432
Mailing address
520 W Huron St
Apt 207
Chicago, IL 60654-3432
Phone (804) 814-3104
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 056010441 | IL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1391558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1391558400000",
"number": "1639593148",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "520 W HURON ST",
"address_2": "APT 207",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606543432",
"telephone_number": "804-814-3104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "520 W HURON ST",
"address_2": "APT 207",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606543432",
"telephone_number": "804-814-3104"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KRISTAN",
"credential": "MS OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-02-05",
"last_updated": "2014-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IL",
"license": "056010441",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 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.