Individual provider Active NPI

Michael Hurston, OT

  • Occupational Therapist
  • Bandon, OR
National Provider Identifier
1114035227
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
979681 Issued in OR
Practice address
913 11TH St SE
Suite 1
Bandon, OR 97411-9168
Phone
(541) 347-4314
Fax
(541) 347-8006
NPI assigned
Aug 28, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 979681 OR Primary

Addresses

Primary practice location

913 11TH St SE
Suite 1
Bandon, OR 97411-9168

Mailing address

913 11TH St SE
Suite 1
Bandon, OR 97411-9168
Phone (541) 347-4314

Other identifiers 1

IdentifierTypeStateIssuer
028176MedicaidOR

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
979681ORMDOccupational Therapist

NPI Registry JSON

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

{
    "created_epoch": "1156723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114035227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "913 11TH ST SE",
            "address_2": "SUITE 1",
            "city": "BANDON",
            "state": "OR",
            "postal_code": "974119168",
            "telephone_number": "541-347-4314",
            "fax_number": "541-347-8006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "913 11TH ST SE",
            "address_2": "SUITE 1",
            "city": "BANDON",
            "state": "OR",
            "postal_code": "974119168",
            "telephone_number": "541-347-4314",
            "fax_number": "541-347-8006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HURSTON",
        "first_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "OR",
            "license": "979681",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "028176",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bandon, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.