Active NPI
Heather Celeste Burt Jordan, OTR/L
- Occupational Therapist
- Raleigh, MS
National Provider Identifier
1780936740
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT2591
- Practice address
- 309 Magnolia Road
Rolling Acres Retirement
Raleigh, MS 39153 - Phone
- (601) 206-9195
- Fax
- (601) 957-8391
- NPI assigned
- Oct 15, 2012
- 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 | OT2591 | MS | Primary |
Addresses
Primary practice location
309 Magnolia Road
Rolling Acres Retirement
Raleigh, MS 39153
Mailing address
P.O. Box 315
Ridgeland, MS 39158
Phone (601) 206-9195
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09014160 | Medicaid | MS |
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 |
|---|---|---|---|
| OT2591 | MS | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Trinity Rehabilitation 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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350259200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350259200000",
"number": "1780936740",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 315",
"city": "RIDGELAND",
"state": "MS",
"postal_code": "39158",
"telephone_number": "601-206-9195",
"fax_number": "601-957-8391"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "309 MAGNOLIA ROAD",
"address_2": "ROLLING ACRES RETIREMENT",
"city": "RALEIGH",
"state": "MS",
"postal_code": "39153",
"telephone_number": "601-206-9195",
"fax_number": "601-957-8391"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURT JORDAN",
"first_name": "HEATHER",
"middle_name": "CELESTE",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-10-15",
"last_updated": "2012-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MS",
"license": "OT2591",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "09014160",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.