Active NPI
Susanne M Smith Roley, MS OTR/L FOATA
- Occupational Therapist
- Aliso Viejo, CA
National Provider Identifier
1104079854
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT 6109
- Practice address
- 15 Songbird LN
Aliso Viejo, CA 92656-1232 - Phone
- (949) 581-1380
- NPI assigned
- Oct 28, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 6109 | CA | Primary |
Addresses
Primary practice location
15 Songbird LN
Aliso Viejo, CA 92656-1232
Mailing address
15 Songbird LN
Aliso Viejo, CA 92656-1232
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OT 030 00 N SU OT006 | Other | CA | BLUE CROSS OF CALIFORNIA |
| OT 6109 | Other | CA | CALIFORNIA BOARD OF OCCUPATIONAL THERAPY |
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
| License | State | Type | Specialty |
|---|---|---|---|
| OT 6109 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225152000000",
"number": "1104079854",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 SONGBIRD LN",
"city": "ALISO VIEJO",
"state": "CA",
"postal_code": "926561232"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 SONGBIRD LN",
"city": "ALISO VIEJO",
"state": "CA",
"postal_code": "926561232",
"telephone_number": "949-581-1380"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH ROLEY",
"first_name": "SUSANNE",
"middle_name": "M",
"credential": "MS OTR/L FOATA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-10-28",
"last_updated": "2008-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "OT 6109",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF CALIFORNIA",
"identifier": "OT 030 00 N SU OT006",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CALIFORNIA BOARD OF OCCUPATIONAL THERAPY",
"identifier": "OT 6109",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Aliso Viejo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.