Individual provider Active NPI

Emma Jane McCleary, OTR/L

  • Occupational Therapist
  • Grand Rapids, MI
National Provider Identifier
1114629821
Registry record updated Mar 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
5201013292 Issued in MI
Practice address
48 Heron Dr NW Apt 101J
Grand Rapids, MI 49534-1642
Phone
(231) 349-4955
NPI assigned
Mar 20, 2023
Last updated
Mar 20, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2023

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 5201013292 MI Primary

Addresses

Primary practice location

48 Heron Dr NW Apt 101J
Grand Rapids, MI 49534-1642

Mailing address

48 Heron Dr NW Apt 101J
Grand Rapids, MI 49534-1642
Phone (231) 349-4955

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230407000193 MI Practitioner - Occupational Therapist in Private Practice 8325413263 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Mi Floortime LLC Occupational Therapist CurrentSince Sep 29, 2024 Accepting new patients

Locations

17216 Van Wagoner Rd
Spring Lake, MI 49456
Phone (231) 740-7812

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1679270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679270400000",
    "number": "1114629821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "48 HERON DR NW APT 101J",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495341642",
            "telephone_number": "231-349-4955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48 HERON DR NW APT 101J",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495341642",
            "telephone_number": "231-349-4955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCLEARY",
        "first_name": "EMMA",
        "middle_name": "JANE",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-20",
        "last_updated": "2023-03-20",
        "certification_date": "2023-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MI",
            "license": "5201013292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.