Active NPI
Jackton Simiyu Khausi, OTRL
- Occupational Therapist
- Mesa, AZ
National Provider Identifier
1740475946
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 3955
- Practice address
- 7255 E Broadway
Mesa, AZ 85208 - Phone
- (480) 901-8844
- NPI assigned
- Sep 11, 2007
- 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 Therapist | 225X00000X | 3955 | AZ | Primary |
Addresses
Primary practice location
7255 E Broadway
Mesa, AZ 85208
Mailing address
3319 E University Dr
#341
Mesa, AZ 85213
Phone (480) 306-7503
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189468800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1189468800000",
"number": "1740475946",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3319 E UNIVERSITY DR",
"address_2": "#341",
"city": "MESA",
"state": "AZ",
"postal_code": "85213",
"telephone_number": "480-306-7503"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7255 E BROADWAY",
"city": "MESA",
"state": "AZ",
"postal_code": "85208",
"telephone_number": "480-901-8844"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHAUSI",
"first_name": "JACKTON",
"middle_name": "SIMIYU",
"name_prefix": "Mr.",
"credential": "OTRL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-09-11",
"last_updated": "2007-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "AZ",
"license": "3955",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.