Active NPI
Sandra Kay Vance
- Occupational Therapist
- Fort Wayne, IN
National Provider Identifier
1104199207
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 31000141A
- Practice address
- 3320 N Clinton St
Fort Wayne, IN 46805-1918 - Phone
- (260) 483-2100
- Fax
- (260) 484-5059
- NPI assigned
- Feb 21, 2012
- 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 | 31000141A | IN | Primary |
Addresses
Primary practice location
3320 N Clinton St
Fort Wayne, IN 46805-1918
Mailing address
3320 N Clinton St
Fort Wayne, IN 46805-1918
Phone (260) 483-2100
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 |
|---|---|---|---|
| 31000141A | IN | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1329782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1329782400000",
"number": "1104199207",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3320 N CLINTON ST",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468051918",
"telephone_number": "260-483-2100",
"fax_number": "260-484-5059"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3320 N CLINTON ST",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468051918",
"telephone_number": "260-483-2100",
"fax_number": "260-484-5059"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANCE",
"first_name": "SANDRA",
"middle_name": "KAY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-02-21",
"last_updated": "2012-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IN",
"license": "31000141A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.