Jennifer Carrillo, OT

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

12569 Issued in CA

Practice address

4900 Elk Grove Blvd # 415
Elk Grove, CA 95758-4188

Phone

(916) 793-4797

NPI assigned

Jul 29, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Jennifer Johnson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1722211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722211200000",
    "number": "1720817711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4900 ELK GROVE BLVD # 415",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957584188",
            "telephone_number": "916-793-4797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 ELK GROVE BLVD # 415",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957584188",
            "telephone_number": "916-793-4797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRILLO",
        "first_name": "JENNIFER",
        "credential": "OT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-29",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CA",
            "license": "12569",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "JOHNSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Caroline Bentley Family Therapist, Inc (SagePoint Intensive Outpatient Program)
• Caroline Bentley Family Therapist, Inc
• Carpe Diem Global Investments, LLC
• Shawna Lee Carr
• Jeffrey Scott Carrick, MD
• Justin Carrillo
• Jean Nicole Carter
• Kaya Carter
• Mary Margaret Carter, RN, NP
• Nicole Carter

• Occupational Therapist in Elk Grove, CA
• Providers in Elk Grove, CA by specialty
• Occupational Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2024; 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.