Melissa Jazmines-Broersma, OTD, MS, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

10991 Issued in CA

Practice address

1714 Arlington Ave
Glendale, CA 91208-1523

Phone

(818) 636-1409

NPI assigned

Apr 21, 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

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

{
    "created_epoch": "1524268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524268800000",
    "number": "1225525587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1714 ARLINGTON AVE",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912081523",
            "telephone_number": "818-636-1409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1714 ARLINGTON AVE",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912081523",
            "telephone_number": "818-636-1409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAZMINES-BROERSMA",
        "first_name": "MELISSA",
        "name_prefix": "Mrs.",
        "credential": "OTD, MS, OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-21",
        "last_updated": "2018-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CA",
            "license": "10991",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in Glendale, CA
• Providers in Glendale, CA by specialty
• Occupational Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 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.