Active NPI
Krystina Gloria Donoghue, OTRL
- Occupational Therapist
- La Porte, IN
National Provider Identifier
1104481480
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 31006084A
- Practice address
- 1509 State St
La Porte, IN 46350-3115 - Phone
- (219) 325-4649
- NPI assigned
- May 2, 2019
- 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 | 31006084A | IN | Primary |
Addresses
Primary practice location
1509 State St
La Porte, IN 46350-3115
Mailing address
1007 Lincolnway
La Porte, IN 46350-3201
Phone (219) 325-4649
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 |
|---|---|---|---|
| 31006084A | IN | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1556755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1556755200000",
"number": "1104481480",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1007 LINCOLNWAY",
"city": "LA PORTE",
"state": "IN",
"postal_code": "463503201",
"telephone_number": "219-325-4649"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1509 STATE ST",
"city": "LA PORTE",
"state": "IN",
"postal_code": "463503115",
"telephone_number": "219-325-4649"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DONOGHUE",
"first_name": "KRYSTINA",
"middle_name": "GLORIA",
"name_prefix": "Mrs.",
"credential": "OTRL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-02",
"last_updated": "2019-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IN",
"license": "31006084A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Porte, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.