Active NPI
Maya Bette Nolan
- Occupational Therapist
- Eagle River, AK
National Provider Identifier
1003501958
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 23749
- Practice address
- 12812 Old Glenn Hwy Ste B2
Eagle River, AK 99577-7002 - Phone
- (907) 290-9595
- NPI assigned
- Apr 6, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 23749 | CA | Primary |
Addresses
Primary practice location
12812 Old Glenn Hwy Ste B2
Eagle River, AK 99577-7002
Mailing address
9 Lincoln Rd
Croton on Hudson, NY 10520-3413
Phone (914) 715-6625
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
| License | State | Type | Specialty |
|---|---|---|---|
| 23749 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1680739200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680739200000",
"number": "1003501958",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9 LINCOLN RD",
"city": "CROTON ON HUDSON",
"state": "NY",
"postal_code": "105203413",
"telephone_number": "914-715-6625"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12812 OLD GLENN HWY STE B2",
"city": "EAGLE RIVER",
"state": "AK",
"postal_code": "995777002",
"telephone_number": "907-290-9595"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NOLAN",
"first_name": "MAYA",
"middle_name": "BETTE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-04-06",
"last_updated": "2023-04-06",
"certification_date": "2023-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "23749",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eagle River, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.