Active NPI
Jennifer Gangi Soper, COTA/L
- Pediatric Occupational Therapist
- Melbourne, FL
National Provider Identifier
1811738297
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- 17838
- Practice address
- 860 Wickham Lakes Dr
Melbourne, FL 32940-2232 - Phone
- (321) 432-2333
- NPI assigned
- Jun 1, 2024
- 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 |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 17838 | FL | Primary |
Addresses
Primary practice location
860 Wickham Lakes Dr
Melbourne, FL 32940-2232
Mailing address
860 Wickham Lakes Dr
Melbourne, FL 32940-2232
Phone (321) 432-2333
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 |
|---|---|---|---|
| 17838 | FL | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1717200000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717200000000",
"number": "1811738297",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "860 WICKHAM LAKES DR",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329402232",
"telephone_number": "321-432-2333"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "860 WICKHAM LAKES DR",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329402232",
"telephone_number": "321-432-2333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANGI SOPER",
"first_name": "JENNIFER",
"name_prefix": "Ms.",
"credential": "COTA/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-06-01",
"last_updated": "2024-06-01",
"certification_date": "2024-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "FL",
"license": "17838",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Melbourne, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.