Active NPI
Jaretta Burk
- Occupational Therapist
- Ruidoso, NM
National Provider Identifier
1750702601
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT3682
- Practice address
- 2002 Sudderth Dr
Ruidoso, NM 88345-6119 - Phone
- (575) 257-2368
- Fax
- (575) 257-2141
- NPI assigned
- Dec 19, 2013
- Last updated
- Sep 14, 2023
- Sex
- Female
- 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 | OT3682 | NM | Primary |
Addresses
Primary practice location
2002 Sudderth Dr
Ruidoso, NM 88345-6119
Mailing address
2002 Sudderth Dr
Ruidoso, NM 88345-6119
Phone (575) 257-2368
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 850441031 | Medicaid | NM |
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 |
|---|---|---|---|
| OT3682 | NM | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1387411200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694649600000",
"number": "1750702601",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2002 SUDDERTH DR",
"city": "RUIDOSO",
"state": "NM",
"postal_code": "883456119",
"telephone_number": "575-257-2368",
"fax_number": "575-257-2141"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2002 SUDDERTH DR",
"city": "RUIDOSO",
"state": "NM",
"postal_code": "883456119",
"telephone_number": "575-257-2368",
"fax_number": "575-257-2141"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURK",
"first_name": "JARETTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-12-19",
"last_updated": "2023-09-14",
"certification_date": "2023-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NM",
"license": "OT3682",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "850441031",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ruidoso, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.