John Dejesus

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

111213 Issued in TX

Practice address

921 Shiloh Rd
Suite C-120
Tyler, TX 75703-1431

Phone

(903) 838-7604

Fax

(817) 789-6849

NPI assigned

Apr 3, 2013

Last updated

Apr 3, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Epic Pediatric Therapy, LP

  • Home Health Agency
  • Hurst, TX
  • NPI 1205023066
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1364947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364947200000",
    "number": "1962745497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 NE LOOP 820",
            "address_2": "BUSINESS TOWER 1; SUITE 200",
            "city": "HURST",
            "state": "TX",
            "postal_code": "760537209",
            "telephone_number": "817-292-8787",
            "fax_number": "817-789-6849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "921 SHILOH RD",
            "address_2": "SUITE C-120",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757031431",
            "telephone_number": "903-838-7604",
            "fax_number": "817-789-6849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEJESUS",
        "first_name": "JOHN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-04-03",
        "last_updated": "2013-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "TX",
            "license": "111213",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149984001",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207164901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dehaven Cataract Surgical Center ,Inc (Dehaven Surgical Center, Inc)
• Dehaven Eye Clinic PA
• Dehaven Eye Clinic PA
• Thomas J. Dehaven, M.D.
• Deity Health Care LLC
• Anabel Del Angel
• Rafael Delacruz, CRNA
• Ruben Benjamin Delarosa, PA-C
• Kelly Delbert
• Angela Delfraisse

• Occupational Therapist in Tyler, TX
• Providers in Tyler, TX by specialty
• Occupational Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.