Active NPI
Jacquelyn Lucido, OTRL
- Occupational Therapist
- Clinton TWP, MI
National Provider Identifier
1134601982
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 5201010242
- Practice address
- 19176 Hall Rd
Clinton TWP, MI 48038 - Phone
- (800) 379-1600
- NPI assigned
- Aug 29, 2018
- Last updated
- Nov 25, 2019
- 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 | 5201010242 | MI | Primary |
Addresses
Primary practice location
19176 Hall Rd
Clinton TWP, MI 48038
Mailing address
61658 Cotswold Dr
Washington, MI 48094-1073
Other practice location 1
23265 Northwestern Hwy Ste 200
Southfield, MI 48075-7707
Phone (248) 996-9428
Other practice location 2
23265 Northwestern Hwy Ste 200
Southfield, MI 48075-7707
Phone (248) 996-9428
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 |
|---|---|---|---|
| 5201010242 | MI | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| A1 Occupational Therapy LLC | 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.
-
- Comprehensive Outpatient Rehabilitation Facility (CORF)
- Southfield, MI
- NPI 1356823116
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1535500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1574640000000",
"number": "1134601982",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "61658 COTSWOLD DR",
"city": "WASHINGTON",
"state": "MI",
"postal_code": "480941073"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19176 HALL RD",
"city": "CLINTON TWP",
"state": "MI",
"postal_code": "48038",
"telephone_number": "800-379-1600"
}
],
"practiceLocations": [
{
"address_1": "23265 Northwestern Hwy Ste 200",
"address_purpose": "LOCATION",
"city": "Southfield",
"state": "MI",
"postal_code": "480757707",
"country_code": "US",
"telephone_number": "248-996-9428",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "23265 Northwestern Hwy Ste 200",
"address_purpose": "LOCATION",
"city": "Southfield",
"state": "MI",
"postal_code": "480757707",
"country_code": "US",
"telephone_number": "248-996-9428",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LUCIDO",
"first_name": "JACQUELYN",
"credential": "OTRL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-08-29",
"last_updated": "2019-11-25",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MI",
"license": "5201010242",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clinton TWP, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.