Active NPI
Jennifer C Debourge, OT
- Occupational Therapist
- Ozark, AL
National Provider Identifier
1760713382
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 3252
- Practice address
- 193 Sam Lisenby Rd
Ozark, AL 36360-3048 - Phone
- (334) 445-6336
- Fax
- (334) 445-6363
- NPI assigned
- Jan 21, 2010
- Last updated
- May 31, 2011
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 056008492 | IL | |
| Occupational Therapist | 225X00000X | 3252 | AL | Primary |
Addresses
Primary practice location
193 Sam Lisenby Rd
Ozark, AL 36360-3048
Mailing address
193 Sam Lisenby Rd
Ozark, AL 36360-3048
Phone (334) 445-6336
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 |
|---|---|---|---|
| 3252 | AL | MD | Occupational Therapist |
| 056008492 | IL | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sumlar Therapy Service, Inc. | Occupational Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1264032000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1306800000000",
"number": "1760713382",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "193 SAM LISENBY RD",
"city": "OZARK",
"state": "AL",
"postal_code": "363603048",
"telephone_number": "334-445-6336",
"fax_number": "334-445-6363"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "193 SAM LISENBY RD",
"city": "OZARK",
"state": "AL",
"postal_code": "363603048",
"telephone_number": "334-445-6336",
"fax_number": "334-445-6363"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEBOURGE",
"first_name": "JENNIFER",
"middle_name": "C",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-01-21",
"last_updated": "2011-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IL",
"license": "056008492",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "AL",
"license": "3252",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ozark, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.