Active NPI
Melissa Wallington, OTR/L
- Occupational Therapist
- Traverse City, MI
National Provider Identifier
1124386362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 5201006637
- Practice address
- 550 Munson Ave
Traverse City, MI 49686-3580 - Phone
- (231) 935-8600
- NPI assigned
- Apr 25, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 4802026 | WI | |
| Occupational Therapist | 225X00000X | 5201006637 | MI | Primary |
Addresses
Primary practice location
550 Munson Ave
Traverse City, MI 49686-3580
Mailing address
550 Munson Ave
Traverse City, MI 49686-3580
Phone (231) 935-8600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952307852 | Medicaid | MI |
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 |
|---|---|---|---|
| 4802026 | WI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1335312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722384000000",
"number": "1124386362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "550 MUNSON AVE",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496863580",
"telephone_number": "231-935-8600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "550 MUNSON AVE",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496863580",
"telephone_number": "231-935-8600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLINGTON",
"first_name": "MELISSA",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-04-25",
"last_updated": "2024-07-31",
"certification_date": "2024-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WI",
"license": "4802026",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MI",
"license": "5201006637",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1952307852",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Traverse City, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.