Individual provider Active NPI

Susan Milliman, OTR

  • Occupational Therapist
  • Traverse City, MI
National Provider Identifier
1043357155
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
5201001414 Issued in MI
Practice address
1650 Barlow St Ste 11
Traverse City, MI 49686-4721
Phone
(231) 941-3100
Fax
(231) 922-0382
NPI assigned
Jan 30, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 5201001414 MI Primary

Addresses

Primary practice location

1650 Barlow St Ste 11
Traverse City, MI 49686-4721

Mailing address

1650 Barlow St Ste 11
Traverse City, MI 49686-4721
Phone (231) 941-3100

Other identifiers 1

IdentifierTypeStateIssuer
P00243970OtherMIRR MEDICARE

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

State licenses

LicenseStateTypeSpecialty
5201001414MIMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Great Lakes Therapy Housecalls, P.C. Past Accepting new patients
Great Lakes Therapy House Calls PC PastSince Jan 5, 2016 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1043357155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 BARLOW ST STE 11",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496864721",
            "telephone_number": "231-941-3100",
            "fax_number": "231-922-0382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 BARLOW ST STE 11",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496864721",
            "telephone_number": "231-941-3100",
            "fax_number": "231-922-0382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLIMAN",
        "first_name": "SUSAN",
        "credential": "OTR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MI",
            "license": "5201001414",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00243970",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.

Verify at the official NPI Registry.