Active NPI
Starr E Kelly, O.T.
- Occupational Therapist
- South Bend, IN
National Provider Identifier
1225259906
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- Practice address
- 2505 E Jefferson Blvd
South Bend, IN 46615-2635 - Phone
- (574) 289-4831
- Fax
- (574) 234-2075
- NPI assigned
- May 1, 2007
- Sex
- Female
- 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 | Primary |
Addresses
Primary practice location
2505 E Jefferson Blvd
South Bend, IN 46615-2635
Mailing address
PO Box 1049
South Bend, IN 46624-1049
Phone (574) 289-4831
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Growing Potentials, LLC | Occupational Therapist | 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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1225259906",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1049",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466241049",
"telephone_number": "574-289-4831",
"fax_number": "574-234-2075"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2505 E JEFFERSON BLVD",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466152635",
"telephone_number": "574-289-4831",
"fax_number": "574-234-2075"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "STARR",
"middle_name": "E",
"credential": "O.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-01",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.