Active NPI
Justin Stephenson Fegley
- Occupational Therapy Assistant
- Daytona Beach, FL
National Provider Identifier
1710401179
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 15996
- Practice address
- 307 Quaker Ridge Dr
Daytona Beach, FL 32119-2383 - Phone
- (386) 847-7342
- NPI assigned
- Jul 27, 2017
- Sex
- Male
- 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 Therapy Assistant | 224Z00000X | 15996 | FL | Primary |
Addresses
Primary practice location
307 Quaker Ridge Dr
Daytona Beach, FL 32119-2383
Mailing address
307 Quaker Ridge Dr
Daytona Beach, FL 32119-2383
Phone (386) 847-7342
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 |
|---|---|---|---|
| 15996 | FL | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1501113600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1710401179",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "307 QUAKER RIDGE DR",
"city": "DAYTONA BEACH",
"state": "FL",
"postal_code": "321192383",
"telephone_number": "386-847-7342"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "307 QUAKER RIDGE DR",
"city": "DAYTONA BEACH",
"state": "FL",
"postal_code": "321192383",
"telephone_number": "386-847-7342"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FEGLEY",
"first_name": "JUSTIN",
"middle_name": "STEPHENSON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-07-27",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "FL",
"license": "15996",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Daytona Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.