Active NPI
Jacquelyn Johnson, OTR/L
- Occupational Therapist
- Princeton, IL
National Provider Identifier
1710241286
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 056.001008
- Practice address
- 530 Park Ave E
Princeton, IL 61356-3901 - Phone
- (815) 876-4494
- Fax
- (815) 876-2030
- NPI assigned
- Jun 29, 2012
- Last updated
- Jun 29, 2012
- 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 | 056.001008 | IL | Primary |
Addresses
Primary practice location
530 Park Ave E
Princeton, IL 61356-3901
Mailing address
530 Park Ave E
Princeton, IL 61356-3901
Phone (815) 876-4494
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 |
|---|---|---|---|
| 056.001008 | IL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340928000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340928000000",
"number": "1710241286",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "530 PARK AVE E",
"city": "PRINCETON",
"state": "IL",
"postal_code": "613563901",
"telephone_number": "815-876-4494",
"fax_number": "815-876-2030"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "530 PARK AVE E",
"city": "PRINCETON",
"state": "IL",
"postal_code": "613563901",
"telephone_number": "815-876-4494",
"fax_number": "815-876-2030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "JACQUELYN",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-29",
"last_updated": "2012-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IL",
"license": "056.001008",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Princeton, IL
- Ihcc Hospice Inc (In-Home Care Connection Hospice Services)
- Ihcc LLC (In-Home Care Connection)
- Illinois Rural Community Care Organization
- Venkata C Jampala, MD
- Jeffrey D Dzik OD & Associates LLC
- Lisa Johnson, LCSW
- Journeys Counseling Assoc Inc
- Julia Rackley Perry Memorial Hospital (Perry Memorial Hospital)
- Julia Rackley Perry Memorial Hospital (Perry Memorial Prompt Care)
- Julia Rackley Perry Memorial Hospital (Perry Memorial Orthopedic & Sports Medicine)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.