Active NPI
Clarion Marshel George
- Occupational Therapy Assistant
- Richton Park, IL
National Provider Identifier
1144935586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 057005061
- Practice address
- 4615 Poplar Ave
Richton Park, IL 60471-1161 - Phone
- (708) 217-0064
- NPI assigned
- Jan 19, 2023
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 057.005061 | IL | |
| Occupational Therapy Assistant | 224Z00000X | 057005061 | IL | Primary |
Addresses
Primary practice location
4615 Poplar Ave
Richton Park, IL 60471-1161
Mailing address
4615 Poplar Ave
Richton Park, IL 60471-1161
Phone (708) 217-0064
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 |
|---|---|---|---|
| 057.005061 | IL | MD | Occupational Therapy Assistant |
| 057005061 | IL | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1674086400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674086400000",
"number": "1144935586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4615 POPLAR AVE",
"city": "RICHTON PARK",
"state": "IL",
"postal_code": "604711161",
"telephone_number": "708-217-0064"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4615 POPLAR AVE",
"city": "RICHTON PARK",
"state": "IL",
"postal_code": "604711161",
"telephone_number": "708-217-0064"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GEORGE",
"first_name": "CLARION",
"middle_name": "MARSHEL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-01-19",
"last_updated": "2023-01-19",
"certification_date": "2023-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "IL",
"license": "057.005061",
"primary": false
},
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "IL",
"license": "057005061",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richton Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 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.