Individual provider Active NPI

Judith Ann Cusimano-Connors, OT

  • Occupational Therapist
  • Port Charlotte, FL
National Provider Identifier
1265141105
Registry record updated Nov 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OT1815 Issued in FL
Practice address
2200 Kings Hwy Unit 2F
Port Charlotte, FL 33980-5760
Phone
(941) 888-4561
Fax
(941) 444-0599
NPI assigned
Nov 18, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X OT1815 FL Primary

Addresses

Primary practice location

2200 Kings Hwy Unit 2F
Port Charlotte, FL 33980-5760

Mailing address

1915 NE 21St Ave
Cape Coral, FL 33909-4625
Phone (239) 850-3416

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
OT1815FLMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Peace River Physical Therapy & Rehabilitation, LLC CurrentSince Nov 20, 2022 Accepting new patients

Locations

2200 Kings Hwy
Unit 2F
Pt Charlotte, FL 33980
Phone (941) 888-4561

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": "1668729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668729600000",
    "number": "1265141105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1915 NE 21ST AVE",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339094625",
            "telephone_number": "239-850-3416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 KINGS HWY UNIT 2F",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339805760",
            "telephone_number": "941-888-4561",
            "fax_number": "941-444-0599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUSIMANO-CONNORS",
        "first_name": "JUDITH",
        "middle_name": "ANN",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-18",
        "last_updated": "2022-11-18",
        "certification_date": "2022-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "FL",
            "license": "OT1815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 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.

Verify at the official NPI Registry.