NPIMap

Organization Active NPI

Jabulani Kids Pediatric Therapy, PC

  • Occupational Therapist
  • Kernersville, NC
National Provider Identifier
1699187385
Registry record updated Dec 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
4696 Issued in NC
Legal business name
JABULANI KIDS PEDIATRIC THERAPY, PC
Practice address
1130 Snow Bridge LN
Suite C
Kernersville, NC 27284-8411
Phone
(336) 310-5828
Fax
(888) 511-1230
NPI assigned
May 29, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2015

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

Authorized official

Name
Mr. Andrew James Silver
Title
Cfo
Phone
(336) 793-3253

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X 4696 NC Primary
Feeding, Eating & Swallowing Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225XF0002X 4696 NC
Mental Health Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225XM0800X 4696 NC
Pediatric Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225XP0200X 4696 NC

Addresses

Primary practice location

1130 Snow Bridge LN
Suite C
Kernersville, NC 27284-8411

Mailing address

PO Box 2061
Kernersville, NC 27285-2061
Phone (336) 310-5828

Other identifiers 2

IdentifierTypeStateIssuer
148A7OtherNCBCBS
7302077MedicaidNC

National Provider Directory

National Provider Directory

Locations

1130 Snow Bridge Ln
#C
Kernersville, NC 27284
Phone (336) 310-5828

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1401321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449532800000",
    "number": "1699187385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2061",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272852061",
            "telephone_number": "336-310-5828",
            "fax_number": "888-511-1230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 SNOW BRIDGE LN",
            "address_2": "SUITE C",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272848411",
            "telephone_number": "336-310-5828",
            "fax_number": "888-511-1230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JABULANI KIDS PEDIATRIC THERAPY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-29",
        "last_updated": "2015-12-08",
        "status": "A",
        "authorized_official_last_name": "SILVER",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "336-793-3253",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "NC",
            "license": "4696",
            "primary": true
        },
        {
            "code": "225XF0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Feeding, Eating & Swallowing",
            "state": "NC",
            "license": "4696",
            "primary": false
        },
        {
            "code": "225XM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Mental Health",
            "state": "NC",
            "license": "4696",
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "NC",
            "license": "4696",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "148A7",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7302077",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kernersville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2015; 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.