NPIMap

Individual provider Active NPI

Mary Catherine Cunningham-Portner, MOT, OTR/L

  • Pediatric Occupational Therapist
  • Weston, FL
National Provider Identifier
1205068657
Registry record updated Aug 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
License
OT11830 Issued in FL
Practice address
2625 Executive Park Dr
Suite 3
Weston, FL 33331-3634
Phone
(954) 385-4696
Fax
(954) 385-8385
NPI assigned
Aug 19, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 28, 2009

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Feeding, Eating & Swallowing Occupational Therapist 225XF0002X OT11830 FL
Mental Health Occupational Therapist 225XM0800X OT11830 FL
Neurorehabilitation Occupational Therapist 225XN1300X OT11830 FL
Pediatric Occupational Therapist 225XP0200X OT11830 FL Primary

Addresses

Primary practice location

2625 Executive Park Dr
Suite 3
Weston, FL 33331-3634

Mailing address

2625 Executive Park Dr
Suite 3
Weston, FL 33331-3634
Phone (954) 385-4696

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

LicenseStateTypeSpecialty
OT11830FLMDPediatric Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Weston Psychcare PA Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1250640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1251417600000",
    "number": "1205068657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2625 EXECUTIVE PARK DR",
            "address_2": "SUITE 3",
            "city": "WESTON",
            "state": "FL",
            "postal_code": "333313634",
            "telephone_number": "954-385-4696",
            "fax_number": "954-385-8385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2625 EXECUTIVE PARK DR",
            "address_2": "SUITE 3",
            "city": "WESTON",
            "state": "FL",
            "postal_code": "333313634",
            "telephone_number": "954-385-4696",
            "fax_number": "954-385-8385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUNNINGHAM-PORTNER",
        "first_name": "MARY",
        "middle_name": "CATHERINE",
        "name_prefix": "Ms.",
        "credential": "MOT, OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-08-19",
        "last_updated": "2009-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XF0002X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Feeding, Eating & Swallowing",
            "state": "FL",
            "license": "OT11830",
            "primary": false
        },
        {
            "code": "225XM0800X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Mental Health",
            "state": "FL",
            "license": "OT11830",
            "primary": false
        },
        {
            "code": "225XN1300X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Neurorehabilitation",
            "state": "FL",
            "license": "OT11830",
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "FL",
            "license": "OT11830",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Weston, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2009; 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.