Active NPI
Nyisha Custis
- Occupational Therapy Assistant
- Salisbury, MD
National Provider Identifier
1154050847
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- A03054
- Practice address
- 100 E Carroll St
Salisbury, MD 21801-5422 - Phone
- (410) 546-6400
- NPI assigned
- Jun 8, 2022
- 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 Therapy Assistant | 224Z00000X | A03054 | MD | Primary |
Addresses
Primary practice location
100 E Carroll St
Salisbury, MD 21801-5422
Mailing address
305A Union Ave
Salisbury, MD 21801-3659
Phone (443) 366-9162
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 |
|---|---|---|---|
| A03054 | MD | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654646400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654646400000",
"number": "1154050847",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "305A UNION AVE",
"city": "SALISBURY",
"state": "MD",
"postal_code": "218013659",
"telephone_number": "443-366-9162"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 E CARROLL ST",
"city": "SALISBURY",
"state": "MD",
"postal_code": "218015422",
"telephone_number": "410-546-6400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CUSTIS",
"first_name": "NYISHA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-06-08",
"last_updated": "2022-06-08",
"certification_date": "2022-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "MD",
"license": "A03054",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salisbury, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.