Individual provider Active NPI

Jordan Alexandra Lombardo, COTA/L

  • Occupational Therapy Assistant
  • Shelby Township, MI
National Provider Identifier
1093694242
Registry record updated Sep 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
5202010268 Issued in MI
Practice address
4200 W Utica Rd
Shelby Township, MI 48317-4766
Phone
(586) 739-5520
NPI assigned
Sep 1, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 1, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 5202010268 MI Primary

Addresses

Primary practice location

4200 W Utica Rd
Shelby Township, MI 48317-4766

Mailing address

12394 Conservation TRL
Shelby Township, MI 48315-3420
Phone (586) 350-7487

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

LicenseStateTypeSpecialty
5202010268MIMDOccupational Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1756684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756684800000",
    "number": "1093694242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12394 CONSERVATION TRL",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483153420",
            "telephone_number": "586-350-7487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 W UTICA RD",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483174766",
            "telephone_number": "586-739-5520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOMBARDO",
        "first_name": "JORDAN",
        "middle_name": "ALEXANDRA",
        "credential": "COTA/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-09-01",
        "last_updated": "2025-09-01",
        "certification_date": "2025-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "MI",
            "license": "5202010268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelby Township, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2025; 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.