Active NPI
Junior Formukong Mbipeh, COTA/L
- Occupational Therapy Assistant
- Newtown Square, PA
National Provider Identifier
1144975178
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 18734
- Practice address
- 3500 W Chester Pike
Newtown Square, PA 19073-4101 - Phone
- (610) 359-4400
- NPI assigned
- Feb 17, 2022
- Sex
- Male
- 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 Therapy Assistant | 224Z00000X | 18734 | FL | Primary |
Addresses
Primary practice location
3500 W Chester Pike
Newtown Square, PA 19073-4101
Mailing address
110 Northwest 135TH Way
BLDG. 46 Apt 301
Plantation, FL 33325
Phone (214) 986-0857
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 |
|---|---|---|---|
| 18734 | FL | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1645056000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714435200000",
"number": "1144975178",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 NORTHWEST 135TH WAY",
"address_2": "BLDG. 46 APT 301",
"city": "PLANTATION",
"state": "FL",
"postal_code": "33325",
"telephone_number": "214-986-0857"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3500 W CHESTER PIKE",
"city": "NEWTOWN SQUARE",
"state": "PA",
"postal_code": "190734101",
"telephone_number": "610-359-4400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MBIPEH",
"first_name": "JUNIOR",
"middle_name": "FORMUKONG",
"credential": "COTA/L",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-02-17",
"last_updated": "2024-04-30",
"certification_date": "2024-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "FL",
"license": "18734",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newtown Square, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 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.