Physician Compare National (NPI:1477015162)

HEALTHCARE PROVIDER: JEREMY NORDMAN OTR/L

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1477015162
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6709213705
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200304001985
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	NORDMAN
	Individual professional last name
Provider First Name	JEREMY
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2015
	Individual professional's medical school graduation year
Primary Specialty	OCCUPATIONAL THERAPY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	95 WALTHALL RD
	Group Practice or individual's line 1 address
City	RUSSELLVILLE
	Group Practice or individual's city
State	AR
	Group Practice or individual's state
Zip Code	728028707
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	M