Active NPI
Marc Andrew Holderead, OTR
- Occupational Therapist
- Marion, IN
National Provider Identifier
1154713493
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 31005616A
- Practice address
- 4411 S Adams St
Marion, IN 46953-5349 - Phone
- (765) 674-4455
- Fax
- (765) 674-3577
- NPI assigned
- Feb 24, 2015
- 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 Therapist | 225X00000X | 31005616A | IN | Primary |
Addresses
Primary practice location
4411 S Adams St
Marion, IN 46953-5349
Mailing address
4411 S Adams St
Marion, IN 46953-5349
Phone (765) 674-4455
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 156540 | Other | IN | MEDICARE |
| 100124000 | Medicaid | IN | |
| 129137500 | Other | IN | US DEPARTMENT OF LABOR |
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 |
|---|---|---|---|
| 31005616A | IN | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Indiana Wesleyan University | Occupational Therapist | Past | Accepting new patients |
| The Center for Sports & Physical Therapy | Occupational Therapist | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Physical Therapist
- Marion, IN
- NPI 1811014681
Occupational Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1424736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424736000000",
"number": "1154713493",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4411 S ADAMS ST",
"city": "MARION",
"state": "IN",
"postal_code": "469535349",
"telephone_number": "765-674-4455",
"fax_number": "765-674-3577"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4411 S ADAMS ST",
"city": "MARION",
"state": "IN",
"postal_code": "469535349",
"telephone_number": "765-674-4455",
"fax_number": "765-674-3577"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLDEREAD",
"first_name": "MARC",
"middle_name": "ANDREW",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-02-24",
"last_updated": "2015-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IN",
"license": "31005616A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "156540",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100124000",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "US DEPARTMENT OF LABOR",
"identifier": "129137500",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marion, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.