Jessica Black, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

0TA14422 Issued in FL

Practice address

1705 Jess Parrish CT
Titusville, FL 32796-2158

Phone

(321) 269-5720

NPI assigned

Apr 24, 2019

Last updated

Apr 24, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1556064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556064000000",
    "number": "1760046973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1691 HENLEY RD NW",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329076328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 JESS PARRISH CT",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327962158",
            "telephone_number": "321-269-5720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "JESSICA",
        "credential": "COTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-24",
        "last_updated": "2019-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "FL",
            "license": "0TA14422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "idonotknow",
            "affiliation": "N",
            "address_1": "1705 Jess Parrish Ct",
            "city": "Titusville",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327962158",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Occupational Therapy Assistant in Titusville, FL
• Providers in Titusville, FL by specialty
• Occupational Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2019; 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.