Active NPI
Sam Angela Jose, OTR/L
- Occupational Therapist
- Lakeland, FL
National Provider Identifier
1821710229
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 23436
- Practice address
- 1215 E Orange St
Lakeland, FL 33801-5762 - Phone
- (863) 802-3800
- NPI assigned
- Sep 13, 2022
- 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 | 23436 | FL | Primary |
Addresses
Primary practice location
1215 E Orange St
Lakeland, FL 33801-5762
Mailing address
7350 Beaumont Dr
Lakeland, FL 33810
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 23136 | Other | FL | LICENSE |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | WebPT | Health Information Exchange (HIE) |
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 |
|---|---|---|---|
| 23436 | FL | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Therapy Services Inc | 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.
-
- Clinic/Center
- Lakeland, FL
- NPI 1407834021
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663113600000",
"number": "1821710229",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7350 BEAUMONT DR",
"city": "LAKELAND",
"state": "FL",
"postal_code": "33810"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1215 E ORANGE ST",
"city": "LAKELAND",
"state": "FL",
"postal_code": "338015762",
"telephone_number": "863-802-3800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOSE",
"first_name": "SAM ANGELA",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-13",
"last_updated": "2022-09-14",
"certification_date": "2022-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "23436",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "23136",
"state": "FL"
}
],
"endpoints": [
{
"endpointType": "SOAP",
"endpointTypeDescription": "SOAP URL",
"endpoint": "WebPT",
"affiliation": "N",
"endpointDescription": "EMR System",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Website",
"address_1": "1215 E Orange St",
"city": "Lakeland",
"state": "FL",
"country_code": "US",
"postal_code": "338015762",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Lakeland, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 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.