Active NPI
Dexter Cervantes, O.T.
- Occupational Therapist
- Peoria, IL
National Provider Identifier
1053554410
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 056008282
- Practice address
- 221 NE Glen Oak Ave
Peoria, IL 61636-0002 - Phone
- (309) 672-5522
- NPI assigned
- Apr 15, 2009
- Last updated
- May 31, 2011
- Sex
- Male
- 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 | 056008282 | IL | Primary |
Addresses
Primary practice location
221 NE Glen Oak Ave
Peoria, IL 61636-0002
Mailing address
1920 Old Springville Rd
Birmingham, AL 35215-5858
Phone (205) 520-9600
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 |
|---|---|---|---|
| 056008282 | IL | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Atlas Home Health Care - Lancaster, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Home Health Agency
- Lancaster, PA
- NPI 1619288644
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1239753600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1306800000000",
"number": "1053554410",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1920 OLD SPRINGVILLE RD",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352155858",
"telephone_number": "205-520-9600",
"fax_number": "205-520-0455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "221 NE GLEN OAK AVE",
"city": "PEORIA",
"state": "IL",
"postal_code": "616360002",
"telephone_number": "309-672-5522"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CERVANTES",
"first_name": "DEXTER",
"credential": "O.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-04-15",
"last_updated": "2011-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IL",
"license": "056008282",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, IL
- Central Illinois Pathology, SC
- Central Illinois Preventive Services LLC
- Central Illinois Radiation Oncology Physicians, LTD
- Central Illinois Radiological Associates, LTD. (Central Illinois Radiological Associates)
- Central Illinois Rehabilitation Associates Inc SC
- Shinymol John Chacko, MD
- Amitoj Singh Chadha, MBBS
- Deboshruti Chakraborty, M.B.B.S
- Shruti Chakravarthy, MD
- Kristen Ann Chambers-Damm, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.