Active NPI
Jonathan Peter Shade, OT
- Occupational Therapist
- Apopka, FL
National Provider Identifier
1740658202
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT1641
- Practice address
- 1509 W Orange Blossom TRL
Apopka, FL 32712-2640 - Phone
- (407) 814-0436
- Fax
- (407) 814-0818
- NPI assigned
- Sep 14, 2015
- 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 | OT1641 | FL | Primary |
Addresses
Primary practice location
1509 W Orange Blossom TRL
Apopka, FL 32712-2640
Mailing address
585 Preston Rd
Longwood, FL 32750-3945
Phone (407) 814-0436
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 |
|---|---|---|---|
| OT1641 | FL | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aqua Rehabilitation, Inc. | Past | Accepting new patients | |
| Vicory Rehabilitation, Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Apopka, FL
- NPI 1023420684
-
- Physical Therapist
- Apopka, FL
- NPI 1184698185
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1442188800000",
"number": "1740658202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "585 PRESTON RD",
"city": "LONGWOOD",
"state": "FL",
"postal_code": "327503945",
"telephone_number": "407-814-0436",
"fax_number": "407-814-0818"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1509 W ORANGE BLOSSOM TRL",
"city": "APOPKA",
"state": "FL",
"postal_code": "327122640",
"telephone_number": "407-814-0436",
"fax_number": "407-814-0818"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHADE",
"first_name": "JONATHAN",
"middle_name": "PETER",
"name_prefix": "Mr.",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-09-14",
"last_updated": "2015-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "OT1641",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Apopka, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 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.