Active NPI
Theresa Flange, M.ED., OTRL
- Occupational Therapist
- Petoskey, MI
National Provider Identifier
1063275980
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 5201004026
- Practice address
- Villa at the Bay
1500 Spring Street
Petoskey, MI 49770 - Phone
- (810) 394-1408
- NPI assigned
- Feb 2, 2024
- Last updated
- Feb 4, 2024
- Sex
- Female
- 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 | 5201004026 | MI | Primary |
Addresses
Primary practice location
Villa at the Bay
1500 Spring Street
Petoskey, MI 49770
Mailing address
313 Bowen St
East Jordan, MI 49727-9759
Phone (810) 394-1408
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
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5201004026 | MI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1706832000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707004800000",
"number": "1063275980",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "313 BOWEN ST",
"city": "EAST JORDAN",
"state": "MI",
"postal_code": "497279759",
"telephone_number": "810-394-1408"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "VILLA AT THE BAY",
"address_2": "1500 SPRING STREET",
"city": "PETOSKEY",
"state": "MI",
"postal_code": "49770",
"telephone_number": "810-394-1408"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FLANGE",
"first_name": "THERESA",
"credential": "M.ED., OTRL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-02-02",
"last_updated": "2024-02-04",
"certification_date": "2024-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MI",
"license": "5201004026",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Petoskey, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.