Active NPI
Andrea Jean Ellensohn, OT
- Occupational Therapist
- Mesa, AZ
National Provider Identifier
1043336167
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 1051
- Practice address
- 1819 S Dobson Rd
Ste 212
Mesa, AZ 85202-5664 - Phone
- (480) 456-0719
- NPI assigned
- Mar 21, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | 1051 | AZ | Primary |
Addresses
Primary practice location
1819 S Dobson Rd
Ste 212
Mesa, AZ 85202-5664
Mailing address
1819 S Dobson Rd
Ste 212
Mesa, AZ 85202-5664
Phone (480) 456-0719
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 947442 | Medicaid | AZ |
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1043336167",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1819 S DOBSON RD",
"address_2": "STE 212",
"city": "MESA",
"state": "AZ",
"postal_code": "852025664",
"telephone_number": "480-456-0719"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1819 S DOBSON RD",
"address_2": "STE 212",
"city": "MESA",
"state": "AZ",
"postal_code": "852025664",
"telephone_number": "480-456-0719"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLENSOHN",
"first_name": "ANDREA",
"middle_name": "JEAN",
"credential": "OT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-21",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "AZ",
"license": "1051",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "947442",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.