Individual provider Active NPI

Jessica Nadeau

  • Pediatric Occupational Therapist
  • Killeen, TX
National Provider Identifier
1821474933
Registry record updated Jun 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
License
116255 Issued in TX
Practice address
1102 Winkler Ave
Killeen, TX 76542
Phone
(254) 634-8505
Fax
(254) 781-4312
NPI assigned
Jul 31, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 46TR00660900 NJ
Pediatric Occupational Therapist 225XP0200X 116255 TX Primary

Addresses

Primary practice location

1102 Winkler Ave
Killeen, TX 76542

Mailing address

605 Donnie Ave
Killeen, TX 76541-8918
Phone (254) 634-8505

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241107002893 TX Practitioner - Occupational Therapist in Private Practice 7810421237 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
46TR00660900NJMDOccupational Therapist
116255TXMDPediatric Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Barr Physical Therapy, P.C. Occupational Therapist CurrentSince Aug 30, 2024 Accepting new patients
San Luis Walk-in Clinic, Inc. PastSince Aug 30, 2024 Accepting new patients
Barr Physical Therapy, P.C. Occupational Therapist Past Accepting new patients

Locations

1102 Winkler Ave
Killeen, TX 76542
Phone (254) 634-8505

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/11823/brand/2/csg/41/fhir/r4

Organizations & group practices 3

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": "1438300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528675200000",
    "number": "1821474933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 DONNIE AVE",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765418918",
            "telephone_number": "254-634-8505",
            "fax_number": "254-781-4312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 WINKLER AVE",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "76542",
            "telephone_number": "254-634-8505",
            "fax_number": "254-781-4312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NADEAU",
        "first_name": "JESSICA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-31",
        "last_updated": "2018-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NJ",
            "license": "46TR00660900",
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "TX",
            "license": "116255",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Killeen, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.