Active NPI
Monique Jackson
- Gerontology Occupational Therapist
- Detroit, MI
National Provider Identifier
1871049684
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Occupational Therapist
- License
- 5202005667
- Practice address
- 21630 Jessel Ave
Detroit, MI 48219 - Phone
- (855) 213-9980
- NPI assigned
- Aug 31, 2016
- 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 |
|---|---|---|---|---|
| Gerontology Occupational Therapist | 225XG0600X | 5202005667 | MI | Primary |
Addresses
Primary practice location
21630 Jessel Ave
Detroit, MI 48219
Mailing address
5460 Woodland Ridge Dr
Flint, MI 48532-2271
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 |
|---|---|---|---|
| 5202005667 | MI | MD | Gerontology Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472601600000",
"number": "1871049684",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5460 WOODLAND RIDGE DR",
"city": "FLINT",
"state": "MI",
"postal_code": "485322271"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21630 JESSEL AVE",
"city": "DETROIT",
"state": "MI",
"postal_code": "48219",
"telephone_number": "855-213-9980"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MONIQUE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-08-31",
"last_updated": "2016-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "225XG0600X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Gerontology",
"state": "MI",
"license": "5202005667",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.