Active NPI
Amy Johnson
- Occupational Therapist
- Revere, MA
National Provider Identifier
1104241264
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 10572
- Practice address
- 19 Overlook Ridge Ter
Apartment 222
Revere, MA 02151-1167 - Phone
- (781) 864-6062
- NPI assigned
- Feb 26, 2014
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 10572 | MA | Primary |
| Occupational Therapist | 225X00000X | 018553-1 | NY |
Addresses
Primary practice location
19 Overlook Ridge Ter
Apartment 222
Revere, MA 02151-1167
Mailing address
19 Overlook Ridge Ter
Apartment 222
Revere, MA 02151-1167
Phone (781) 864-6062
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 |
|---|---|---|---|
| 018553 | NY | MD | Physical Therapist |
| 018553-1 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1393372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393372800000",
"number": "1104241264",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19 OVERLOOK RIDGE TER",
"address_2": "APARTMENT 222",
"city": "REVERE",
"state": "MA",
"postal_code": "021511167",
"telephone_number": "781-864-6062"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19 OVERLOOK RIDGE TER",
"address_2": "APARTMENT 222",
"city": "REVERE",
"state": "MA",
"postal_code": "021511167",
"telephone_number": "781-864-6062"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "AMY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-02-26",
"last_updated": "2014-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MA",
"license": "10572",
"primary": true
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NY",
"license": "018553-1",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Revere, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.