Jacob Clevenger, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

280029 Issued in KY

Practice address

1710 Ky-121 Suite K
Murray, KY 42071

Phone

(270) 767-6397

NPI assigned

Oct 11, 2019

Reactivated

Jan 4, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1570752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673222400000",
    "number": "1639711559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2110 VINTAGE HILLS DR APT A",
            "city": "MURRAY",
            "state": "KY",
            "postal_code": "420714780",
            "telephone_number": "931-619-1564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 KY-121 SUITE K",
            "city": "MURRAY",
            "state": "KY",
            "postal_code": "42071",
            "telephone_number": "270-767-6397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEVENGER",
        "first_name": "JACOB",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-10-11",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-05",
        "deactivation_date": "2022-12-29",
        "reactivation_date": "2023-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "KY",
            "license": "280029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Elisabeth Chase, D.C.
• Ryan Wesley Chasseur, PHARMD
• Hollis J Clark, MD
• Nathan Blaine Clark, APRN
• Tia A Clark, APRN, FNP-C
• Aliya Grace Clough, CCC-SLP
• Chadwick Hunter Cochran, PHARM.D.
• Katrina A Coffelt, LPCC
• Madison Taylor Cohoon
• Community Living in Kentucky, LLC

• Occupational Therapist in Murray, KY
• Providers in Murray, KY by specialty
• Occupational Therapist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2023; 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.