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1790345940 NPI number — JAREL RUSSELL OTD, OTR/L

NPI Number: 1790345940
Health Care Provider/Practitioner: JAREL RUSSELL OTD, OTR/L

Information about “1790345940” NPI (JAREL RUSSELL OTD, OTR/L) exists in 1790345940 in HTML format HTML  |  1790345940 in plain Text format TXT  |  1790345940 in PDF (Portable Document Format) PDF  |  1790345940 in an XML format XML  formats.

NPI Number : 1790345940 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1790345940",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RUSSELL",
    "FirstName": "JAREL",
    "MiddleName": null,
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "OTD, OTR/L",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3551 ROGER BROOKE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FORT SAM HOUSTON",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "78234-4504",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "213-948-9556",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3551 ROGER BROOKE DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FORT SAM HOUSTON",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "78234-4504",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "213-948-9556",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/19/2019",
    "LastUpdateDate": "04/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "225X00000X",
          "TaxonomyName": "Occupational Therapist",
          "LicenseNumber": "20116",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225X00000X",
          "TaxonomyName": "Occupational Therapist",
          "LicenseNumber": "OT-2951",
          "LicenseNumberStateCode": "NV",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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