Cortney Carlisle

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

5201010171 Issued in MI

Practice address

9809 Cherry Valley Ave SE Ste D
Caledonia, MI 49316-9592

Phone

(269) 223-7786

NPI assigned

Mar 14, 2014

Last updated

Apr 3, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Functional Kids Therapy Center LLC

  dba Functional Kids

  • Pediatric Occupational Therapist
  • Springfield, MI
  • NPI 1578951380
  NPD (past) Authorized official

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

{
    "created_epoch": "1394755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522713600000",
    "number": "1114343068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1460 HIDDEN CREEK CIRCLE DR NE APT C",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495055472",
            "telephone_number": "218-929-9595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9809 CHERRY VALLEY AVE SE STE D",
            "city": "CALEDONIA",
            "state": "MI",
            "postal_code": "493169592",
            "telephone_number": "269-223-7786"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "29 N Academy St",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "296012629",
            "country_code": "US",
            "telephone_number": "864-331-1446",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARLISLE",
        "first_name": "CORTNEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-14",
        "last_updated": "2018-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MI",
            "license": "5201010171",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "SC",
            "license": "4261",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jackson Byiringiro
• Nicki J Cain-Rinckey, MD
• Caledonia Vision Center, PLC (MKG Vision)
• Careatc
• Careatc - Caledonia
• Carruthers Therapy LLC
• Kathy A Carruthers, LMSW
• Laura Mechele Casey-Bir, IBCLC
• Patricia Brunck Cassell, LMSW
• Sarah Anne Chamberlain, PHARMD

• Occupational Therapist in Caledonia, MI
• Providers in Caledonia, MI by specialty
• Occupational Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2018; 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.