Active NPI
Tina L. Soukup, OT
- Occupational Therapist
- Mentor, OH
National Provider Identifier
1124339205
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT-4850
- Practice address
- 6451 Center St
Mentor, OH 44060-4109 - Phone
- (440) 255-4444
- NPI assigned
- Jun 23, 2010
- 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 | OT-4850 | OH | Primary |
Addresses
Primary practice location
6451 Center St
Mentor, OH 44060-4109
Mailing address
6451 Center St
Mentor, OH 44060-4109
Phone (440) 255-4444
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0747777 | Medicaid | OH |
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
| License | State | Type | Specialty |
|---|---|---|---|
| OT-4850 | OH | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mentor Exempted Village School District | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Local Education Agency (LEA)
- Mentor, OH
- NPI 1245550243
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1277251200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398988800000",
"number": "1124339205",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6451 CENTER ST",
"city": "MENTOR",
"state": "OH",
"postal_code": "440604109",
"telephone_number": "440-255-4444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6451 CENTER ST",
"city": "MENTOR",
"state": "OH",
"postal_code": "440604109",
"telephone_number": "440-255-4444"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUKUP",
"first_name": "TINA",
"middle_name": "L.",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-06-23",
"last_updated": "2014-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "OH",
"license": "OT-4850",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0747777",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mentor, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 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.