Individual provider Active NPI

Jessica Williams Koesters, OTR/L

  • Occupational Therapist
  • Aiken, SC
National Provider Identifier
1750669487
Registry record updated Sep 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
3596 Issued in SC
Practice address
123 Dupont Dr NW
Aiken, SC 29801
Phone
(803) 648-0434
NPI assigned
Jul 29, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 3596 SC Primary

Addresses

Primary practice location

123 Dupont Dr NW
Aiken, SC 29801

Mailing address

151 Stone Mill Dr
Martinez, GA 30907-1659
Phone (803) 308-2221

Other practice location 1

309 E Morehead St
Suite 200
Charlotte, NC 28202-2301
Phone (704) 887-4409

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200127001771 NC Practitioner - Occupational Therapist in Private Practice 3577998228 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Medical University of South Carolina College of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Healthcare Services IncGroup PAC ID 2163339722, 3,431 clinicians

Practice addresses (Care Compare)

10820 Penny Rd
Cary, NC 27518-1916
Phone (919) 303-7068

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3596SCMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Low Vision Rehab Solutions, LLC Occupational Therapist CurrentSince Oct 1, 2021 Accepting new patients

Locations

100 Parkway Office Ct
Ste 202
Cary, NC 27518
Phone (919) 239-4805

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.

NPI Registry JSON

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

{
    "created_epoch": "1311897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536278400000",
    "number": "1750669487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 STONE MILL DR",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309071659",
            "telephone_number": "803-308-2221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 DUPONT DR NW",
            "city": "AIKEN",
            "state": "SC",
            "postal_code": "29801",
            "telephone_number": "803-648-0434"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "309 E Morehead St",
            "address_2": "Suite 200",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282022301",
            "country_code": "US",
            "telephone_number": "704-887-4409",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOESTERS",
        "first_name": "JESSICA",
        "middle_name": "WILLIAMS",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-29",
        "last_updated": "2018-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "SC",
            "license": "3596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aiken, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.