Active NPI
Bradley Lemond Wilson, LMT, COTA/L
- Massage Therapist
- Carmel, IN
National Provider Identifier
1134443005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT2207871
- Practice address
- 10293 N Meridian St Ste 125
Carmel, IN 46290-1123 - Phone
- (317) 316-7128
- NPI assigned
- Mar 22, 2010
- Sex
- Male
- 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 Therapy Assistant | 224Z00000X | |||
| Massage Therapist | 225700000X | MT2207871 | IN | Primary |
Addresses
Primary practice location
10293 N Meridian St Ste 125
Carmel, IN 46290-1123
Mailing address
28415 N Duck Creek Ave
Atlanta, IN 46031-9747
Phone (317) 316-7128
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1070991 | Other | NATIONAL BOARD OF CERTIFICATION IN OCCUPATIONAL THERAPY, INC. | |
| MT2207871 | Other | IN | INDIANA PROFESSIONAL LICENSING AGENCY |
| 32001316A | Other | IN | INDIANA PROFESSIONAL LICENSING AGENCY: OCCUPATIONAL THERAPY COMMITTEE |
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 |
|---|---|---|---|
| MT2207871 | IN | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Careerstaff Unlimited | 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 and National Provider Directory roles.
-
- Long Term Care Hospital
- Carmel, IN
- NPI 1033427422
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1269216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680652800000",
"number": "1134443005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28415 N DUCK CREEK AVE",
"city": "ATLANTA",
"state": "IN",
"postal_code": "460319747",
"telephone_number": "317-316-7128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10293 N MERIDIAN ST STE 125",
"city": "CARMEL",
"state": "IN",
"postal_code": "462901123",
"telephone_number": "317-316-7128"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "BRADLEY",
"middle_name": "LEMOND",
"credential": "LMT, COTA/L",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-03-22",
"last_updated": "2023-04-05",
"certification_date": "2023-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": null,
"license": null,
"primary": false
},
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "IN",
"license": "MT2207871",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATIONAL BOARD OF CERTIFICATION IN OCCUPATIONAL THERAPY, INC.",
"identifier": "1070991",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDIANA PROFESSIONAL LICENSING AGENCY",
"identifier": "MT2207871",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDIANA PROFESSIONAL LICENSING AGENCY: OCCUPATIONAL THERAPY COMMITTEE",
"identifier": "32001316A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Carmel, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.