Active NPI
Mikaela Jade Brock
- Occupational Therapist
- Colorado Springs, CO
National Provider Identifier
1083307227
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT.0007579
- Practice address
- 2776 Janitell Rd
Colorado Springs, CO 80906-4103 - Phone
- (719) 332-4689
- NPI assigned
- Jun 1, 2023
- 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 | OT.0007579 | CO | Primary |
Addresses
Primary practice location
2776 Janitell Rd
Colorado Springs, CO 80906-4103
Mailing address
6077 Mumford Dr
Colorado Springs, CO 80925-8472
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT.0007579 | CO | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1685577600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1685577600000",
"number": "1083307227",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6077 MUMFORD DR",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809258472"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2776 JANITELL RD",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809064103",
"telephone_number": "719-332-4689"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROCK",
"first_name": "MIKAELA",
"middle_name": "JADE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-06-01",
"last_updated": "2023-06-01",
"certification_date": "2023-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CO",
"license": "OT.0007579",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.