NPIMap

Individual provider Active NPI

Constance Racine Radford, MSOT

  • Occupational Therapist
  • Jacksonville, IL
National Provider Identifier
1992076533
Registry record updated Apr 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
056.009697 Issued in IL
Practice address
1600 W Walnut St
Jacksonville, IL 62650-1136
Phone
(447) 784-2520
NPI assigned
Jan 12, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X
Occupational Therapist 225X00000X 056.009697 IL Primary

Addresses

Primary practice location

1600 W Walnut St
Jacksonville, IL 62650-1136

Mailing address

4630 Fairvista Dr
Charlotte, NC 28269-1098
Phone (314) 954-5785

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

LicenseStateTypeSpecialty
056.009697ILMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ability First Pediatrics, LLC Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1326326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744934400000",
    "number": "1992076533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4630 FAIRVISTA DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282691098",
            "telephone_number": "314-954-5785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W WALNUT ST",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626501136",
            "telephone_number": "447-784-2520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADFORD",
        "first_name": "CONSTANCE",
        "middle_name": "RACINE",
        "name_prefix": "Mrs.",
        "credential": "MSOT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-12",
        "last_updated": "2025-04-18",
        "certification_date": "2025-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056.009697",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2025; 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.