NPIMap

Organization Active NPI

Jacqueline Kozak

  • Occupational Medicine Clinic/Center
  • Georgetown, TX
National Provider Identifier
1699482448
Registry record updated Dec 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Medicine Clinic/CenterTaxonomy code 261QX0100X
Legal business name
JACQUELINE KOZAK
Practice address
4402 Williams Dr
115
Georgetown, TX 78628-1388
Phone
(512) 256-7627
NPI assigned
Nov 1, 2022
Last updated
Dec 9, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2022

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

Authorized official

Name
Jacqueline KozakNPI 1356056170
Title
Occupational Therapist
Phone
(574) 361-7304

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Medicine Clinic/Center 261QX0100X NU Primary

Addresses

Primary practice location

4402 Williams Dr
115
Georgetown, TX 78628-1388

Mailing address

4402 Williams Dr Ste 115
Georgetown, TX 78628-1388
Phone (512) 256-7627

Other identifiers 1

IdentifierTypeStateIssuer
15748686OtherCAQH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jackiek@allcaretherapygt.com Direct

National Provider Directory

National Provider Directory

Locations

4402 Williams Dr
Ste 115
Georgetown, TX 78628
Phone (512) 256-7627

Practitioners & affiliated clinicians

Practitioners 63

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 63

NPI Registry JSON

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

{
    "created_epoch": "1667260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670544000000",
    "number": "1699482448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4402 WILLIAMS DR STE 115",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786281388",
            "telephone_number": "512-256-7627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4402 WILLIAMS DR",
            "address_2": "115",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786281388",
            "telephone_number": "512-256-7627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACQUELINE KOZAK",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-01",
        "last_updated": "2022-12-09",
        "certification_date": "2022-11-11",
        "status": "A",
        "authorized_official_last_name": "KOZAK",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "OCCUPATIONAL THERAPIST",
        "authorized_official_telephone_number": "574-361-7304"
    },
    "taxonomies": [
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "15748686",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jackiek@allcaretherapygt.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4402 Williams Dr Ste 115",
            "city": "Georgetown",
            "state": "TX",
            "country_code": "US",
            "postal_code": "786281388",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Georgetown, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2022; 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.