Active NPI
Mikeisha Mangham, OTR/L
- Occupational Therapist
- Gainesville, FL
National Provider Identifier
1205584067
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 22787
- Practice address
- 75 SW 75TH St Apt C01
Gainesville, FL 32607-1602 - Phone
- (352) 363-4059
- NPI assigned
- Mar 11, 2022
- Reactivated
- Mar 29, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 | 22787 | FL | Primary |
Addresses
Primary practice location
75 SW 75TH St Apt C01
Gainesville, FL 32607-1602
Mailing address
75 SW 75TH St Apt C01
Gainesville, FL 32607-1602
Phone (352) 363-4059
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22787 | FL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1646956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1650844800000",
"number": "1205584067",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "75 SW 75TH ST APT C01",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326071602",
"telephone_number": "352-363-4059"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 SW 75TH ST APT C01",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326071602",
"telephone_number": "352-363-4059"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANGHAM",
"first_name": "MIKEISHA",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-03-11",
"last_updated": "2022-04-25",
"certification_date": "2022-04-25",
"deactivation_date": "2022-03-11",
"reactivation_date": "2022-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "22787",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 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.