Active NPI
Jacqueline Connolly
- Occupational Therapist
- Wellesley, MA
National Provider Identifier
1699218339
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 12138
- Practice address
- 49 Walnut St
BLDG. 3
Wellesley, MA 02481-2117 - Phone
- (781) 239-0100
- NPI assigned
- Nov 29, 2016
- 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 Therapist | 225X00000X | 12138 | MA | Primary |
Addresses
Primary practice location
49 Walnut St
BLDG. 3
Wellesley, MA 02481-2117
Mailing address
49 Walnut St
BLDG. 3
Wellesley, MA 02481-2117
Phone (781) 239-0100
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 |
|---|---|---|---|
| 12138 | MA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1480377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1483920000000",
"number": "1699218339",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "49 WALNUT ST",
"address_2": "BLDG. 3",
"city": "WELLESLEY",
"state": "MA",
"postal_code": "024812117",
"telephone_number": "781-239-0100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "49 WALNUT ST",
"address_2": "BLDG. 3",
"city": "WELLESLEY",
"state": "MA",
"postal_code": "024812117",
"telephone_number": "781-239-0100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNOLLY",
"first_name": "JACQUELINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-11-29",
"last_updated": "2017-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MA",
"license": "12138",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wellesley, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.