Active NPI
Kourtney Jackson, MS, OTR/L
- Occupational Therapist
- Fresno, CA
National Provider Identifier
1720443823
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 15206
- Practice address
- 1665 M St
Fresno, CA 93721-1121 - Phone
- (559) 268-5361
- NPI assigned
- Dec 16, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OTR2640 | AR | |
| Occupational Therapist | 225X00000X | 15206 | CA | Primary |
Addresses
Primary practice location
1665 M St
Fresno, CA 93721-1121
Mailing address
4018 S P St
Fort Smith, AR 72903-3026
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)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OTR2640 | AR | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1450224000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1450224000000",
"number": "1720443823",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4018 S P ST",
"city": "FORT SMITH",
"state": "AR",
"postal_code": "729033026"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1665 M ST",
"city": "FRESNO",
"state": "CA",
"postal_code": "937211121",
"telephone_number": "559-268-5361"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KOURTNEY",
"credential": "MS, OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-12-16",
"last_updated": "2015-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "AR",
"license": "OTR2640",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "15206",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 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.