Active NPI
Autumn Jessica Carroll, OTR/L
- Occupational Therapist
- Portland, OR
National Provider Identifier
1871691014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 1034600
- Practice address
- 2701 NW Vaughn St
Portland, OR 97210-5311 - Phone
- (503) 721-6800
- NPI assigned
- Sep 20, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 1034600 | OR | Primary |
| Occupational Therapist | 225X00000X | OT00004159 | WA |
Addresses
Primary practice location
2701 NW Vaughn St
Portland, OR 97210-5311
Mailing address
2114 N Sumner St
Portland, OR 97217-3831
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 |
|---|---|---|---|
| 1034600 | OR | MD | Occupational Therapist |
| OT00004159 | WA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1279152000000",
"number": "1871691014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2114 N SUMNER ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972173831"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2701 NW VAUGHN ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972105311",
"telephone_number": "503-721-6800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARROLL",
"first_name": "AUTUMN",
"middle_name": "JESSICA",
"name_prefix": "Mrs.",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-20",
"last_updated": "2010-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "OR",
"license": "1034600",
"primary": true
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WA",
"license": "OT00004159",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.