Richelle Jeannine Drake, CLT, MT

Primary specialty

Orthotic FitterTaxonomy code 225000000X

Practice address

15117 Haynes St.
Van Nuys, CA 91411-1418

Phone

(818) 901-6555

Fax

(818) 901-6555

NPI assigned

Dec 22, 2011

Last updated

Dec 22, 2011By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Medical Technician

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

{
    "created_epoch": "1324512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324512000000",
    "number": "1164791935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15117 HAYNES ST.",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914111418",
            "telephone_number": "818-901-6555",
            "fax_number": "818-901-6555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15117 HAYNES ST.",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914111418",
            "telephone_number": "818-901-6555",
            "fax_number": "818-901-6555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DRAKE",
        "first_name": "RICHELLE",
        "middle_name": "JEANNINE",
        "name_prefix": "Mrs.",
        "credential": "CLT, MT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-12-22",
        "last_updated": "2011-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225000000X",
            "taxonomy_group": "",
            "desc": "Orthotic Fitter",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthotic Fitter in Van Nuys, CA
• Providers in Van Nuys, CA by specialty
• Orthotic Fitter in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2011; 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.