Active NPI
Amanda Jaquez
- Occupational Therapist
- Titusville, FL
National Provider Identifier
1861926974
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT18399
- Practice address
- 5045 Volusia Ave
Titusville, FL 32780-6829 - Phone
- (484) 577-7291
- NPI assigned
- Apr 14, 2017
- Reactivated
- Feb 1, 2023
- Sex
- Female
- Sole proprietor
- Yes
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 | OT18399 | FL | Primary |
Addresses
Primary practice location
5045 Volusia Ave
Titusville, FL 32780-6829
Mailing address
5045 Volusia Ave
Titusville, FL 32780-6829
Phone (484) 577-7291
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 |
|---|---|---|---|
| OT18399 | FL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1492128000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675209600000",
"number": "1861926974",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5045 VOLUSIA AVE",
"city": "TITUSVILLE",
"state": "FL",
"postal_code": "327806829",
"telephone_number": "484-577-7291"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5045 VOLUSIA AVE",
"city": "TITUSVILLE",
"state": "FL",
"postal_code": "327806829",
"telephone_number": "484-577-7291"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAQUEZ",
"first_name": "AMANDA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-04-14",
"last_updated": "2023-02-01",
"certification_date": "2023-02-01",
"deactivation_date": "2018-03-15",
"reactivation_date": "2023-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "OT18399",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Titusville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.