Lisa Marie Shimp, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

5202007926 Issued in MI

Practice address

111 Lakeside Dr NE
Grand Rapids, MI 49503-3811

Phone

(616) 588-1645

NPI assigned

Oct 9, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1539043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539043200000",
    "number": "1154896827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9262 160TH AVE",
            "city": "WEST OLIVE",
            "state": "MI",
            "postal_code": "494609193",
            "telephone_number": "616-990-0970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 LAKESIDE DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495033811",
            "telephone_number": "616-588-1645"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3600 Fulton St E",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495461322",
            "country_code": "US",
            "telephone_number": "616-949-4971",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "280 W 40th St",
            "address_purpose": "LOCATION",
            "city": "Holland",
            "state": "MI",
            "postal_code": "494234664",
            "country_code": "US",
            "telephone_number": "616-990-0970",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1551 Franklin St SE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495068203",
            "country_code": "US",
            "telephone_number": "616-452-1568",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHIMP",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "credential": "COTA/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-10-09",
        "last_updated": "2018-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "MI",
            "license": "5202007926",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "235310",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "235667",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "235378",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "235401",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lindsey Marie Thornton Shigemoto, CD(DONA)
• Shlama Matthew Shikwana, RPH
• Tyler James Shilton, LMT
• Margaret Ann Shimkus, NP
• Eric Shimmel, LMSW
• Andrew J. Shin, MD
• Minnie Shinal
• Shine Therapy PLLC
• Olivia Shinrock
• Cody W Shipley, PMHNP-BC

• Occupational Therapy Assistant in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Occupational Therapy Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.