Jaclyn Oldenburg, MS, OT

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

5201011646 Issued in MI

Practice address

16760 Lincoln St
Grand Haven, MI 49417-8864

Phone

(616) 935-3300

Fax

(616) 935-3333

NPI assigned

Nov 1, 2021

Last updated

Jul 10, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1635724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688947200000",
    "number": "1003571431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 MAMARONECK AVE STE 140",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106055224",
            "telephone_number": "914-294-4050",
            "fax_number": "631-760-8306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16760 LINCOLN ST",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494178864",
            "telephone_number": "616-935-3300",
            "fax_number": "616-935-3333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLDENBURG",
        "first_name": "JACLYN",
        "credential": "MS, OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-01",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MI",
            "license": "5201011646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kayla Norton
• Bridget Nucum
• Kendra Bedient Nyhof, NP
• Hannah H O'Brien, PA-C
• Michael A Okkerse, CRNA
• Marilena C Oravitan, MD
• Orthopaedic Associates of Muskegon, PC
• Orthopaedic Associates of Muskegon, PC
• Joseph Daniel Ortiz, MD
• Stephanie Osborn, DPT

• Occupational Therapist in Grand Haven, MI
• Providers in Grand Haven, MI by specialty
• Occupational Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.

Verify at the official NPI Registry.