Jaclyn M Brown, DROT, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT00003236 Issued in WA

Practice address

9951 Mickelberry Rd NW Ste 123
Silverdale, WA 98383-8309

Phone

(360) 908-5110

NPI assigned

Aug 23, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Jaclyn M Roadruck Former name

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 and National Provider Directory roles.

• Apple Tree Therapy LLC

  • Occupational Therapist
  • Silverdale, WA
  • NPI 1063844827
  NPD (past) Authorized official

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636934400000",
    "number": "1972610459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4225 PINE AVE NE",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983109793",
            "telephone_number": "360-908-5110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9951 MICKELBERRY RD NW STE 123",
            "city": "SILVERDALE",
            "state": "WA",
            "postal_code": "983838309",
            "telephone_number": "360-908-5110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "JACLYN",
        "middle_name": "M",
        "credential": "DROT, OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-23",
        "last_updated": "2021-11-15",
        "certification_date": "2021-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AK",
            "license": "1805",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "OT00003236",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WA",
            "license": "OT00003236",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "5334RO",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACLYN",
            "last_name": "ROADRUCK",
            "middle_name": "M",
            "credential": "OTR/L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Laurence M. Brostoff, M.D.
• Brittney Christina Brown, DMD
• Carlee Brown
• Dawson S Brown, M.D.
• Douglas Edward Brown, M.D.
• Schelby Bryant
• Richard Dwight Buckham Jr., PHD
• Amy Buckley
• Jaclyn Buczkowski
• Erica Y Bunker, PA

• All providers in Silverdale, WA
• Occupational Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2021; 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.