Carmen Carrillo, MOT, OTRL

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

5201011217 Issued in MI

Practice address

6625 Daly Rd
West Bloomfield, MI 48322-3410

Phone

(248) 737-3430

Fax

(248) 737-3433

NPI assigned

Mar 29, 2021

Last updated

Mar 29, 2021By 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

Enrolled in MI

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Kaufman Childrens Center for Speech Language Sensory Motor Soc Connect

  • Speech-Language Pathologist
  • West Bloomfield, MI
  • NPI 1801011812
  Medicare reassignment
• Kaufman Children's Center

  • Behavior Analyst
  • West Bloomfield, MI
  • NPI 1366877318
  NPD (past)

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

{
    "created_epoch": "1616976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616976000000",
    "number": "1053999565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6625 DALY RD",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483223410",
            "telephone_number": "248-737-3430",
            "fax_number": "248-737-3433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6625 DALY RD",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483223410",
            "telephone_number": "248-737-3430",
            "fax_number": "248-737-3433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRILLO",
        "first_name": "CARMEN",
        "credential": "MOT, OTRL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-29",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MI",
            "license": "5201011217",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in West Bloomfield, MI
• Providers in West Bloomfield, MI by specialty
• Occupational Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.