Darcie A Gresham, OTR

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

31001235A Issued in IN

Practice address

6040 Lute Rd
Portage, IN 46368-5008

Phone

(219) 763-6858

Fax

(219) 763-4858

NPI assigned

Jul 10, 2007

Last updated

Jul 10, 2007By 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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1184025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184025600000",
    "number": "1063610137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "262 HILLCREST AVE",
            "city": "HOBART",
            "state": "IN",
            "postal_code": "463423587",
            "telephone_number": "219-945-4955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6040 LUTE RD",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463685008",
            "telephone_number": "219-763-6858",
            "fax_number": "219-763-4858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRESHAM",
        "first_name": "DARCIE",
        "middle_name": "A",
        "credential": "OTR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-10",
        "last_updated": "2007-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IN",
            "license": "31001235A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTR",
            "identifier": "31001235A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in Portage, IN
• Providers in Portage, IN by specialty
• Occupational Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.