Active NPI
Nicole Montgomery, COTAL
- Occupational Therapy Assistant
- Holt, MI
National Provider Identifier
1053865477
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 5202008148
- Practice address
- 5091 Willoughby Rd
Holt, MI 48842-1054 - Phone
- (517) 694-2144
- NPI assigned
- Aug 15, 2016
- 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 Therapy Assistant | 224Z00000X | 5202008148 | MI | Primary |
Addresses
Primary practice location
5091 Willoughby Rd
Holt, MI 48842-1054
Mailing address
10439 Nixon Rd
Grand Ledge, MI 48837-9455
Phone (586) 883-1159
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 |
|---|---|---|---|
| 5202008148 | MI | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1471219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583280000000",
"number": "1053865477",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10439 NIXON RD",
"city": "GRAND LEDGE",
"state": "MI",
"postal_code": "488379455",
"telephone_number": "586-883-1159"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5091 WILLOUGHBY RD",
"city": "HOLT",
"state": "MI",
"postal_code": "488421054",
"telephone_number": "517-694-2144"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONTGOMERY",
"first_name": "NICOLE",
"credential": "COTAL",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-08-15",
"last_updated": "2020-03-04",
"certification_date": "2020-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "MI",
"license": "5202008148",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Holt, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.