Susan J Jacksland, OTR

Primary specialty

SpecialistTaxonomy code 174400000X

License

OT4353 Issued in FL

Practice address

1990 New Haven Avenue
Suite 105
Melbourne, FL 32904

Phone

(321) 773-1737

Fax

(321) 773-1737

NPI assigned

Mar 26, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Susan J Adams Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Florida Therapy Center of Melbourne LLC

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Melbourne, FL
  • NPI 1144288986
  NPD (past)
• Whole-Sum Therapies Inc

  • Speech-Language Pathologist
  • Winter Park, FL
  • NPI 1831413665
  NPD (past)

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668038400000",
    "number": "1790803229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3417 SLATE STREET",
            "city": "WEST MELBOURNE",
            "state": "FL",
            "postal_code": "329047593",
            "telephone_number": "407-242-7070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1990 NEW HAVEN AVENUE",
            "address_2": "SUITE 105",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "32904",
            "telephone_number": "321-773-1737",
            "fax_number": "321-773-1737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSLAND",
        "first_name": "SUSAN",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "OTR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-26",
        "last_updated": "2022-11-10",
        "certification_date": "2022-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "OT0004353",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "OT4353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "ADAMS",
            "middle_name": "J",
            "credential": "OTR",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Steven Laurence Israel, M.D.
• Abdimomun Iuldashev, M.D.
• Andrea Izquierdo, DOM, LAC
• J Phyllis Brannen LCSW Cap
• Amber Jack, APRN
• Audrey Lee Farson Jackson, APRN
• Jessica Jackson
• Tiye Jackson, PTA
• Valerie P. Jackson, MA
• William Lemar Jackson Jr., MD

• Specialist in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2022; 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.