Active NPI
Nicole Anderson, OT
- Occupational Therapist
- Modena, NY
National Provider Identifier
1275074148
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 021282-1
- Practice address
- 2176 State Route 32
Modena, NY 12548-5211 - Phone
- (845) 514-5557
- NPI assigned
- Mar 13, 2017
- Last updated
- Apr 5, 2019
- 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 | 021282-1 | NY | Primary |
Addresses
Primary practice location
2176 State Route 32
Modena, NY 12548-5211
Mailing address
2176 State Route 32
Modena, NY 12548-5211
Phone (845) 514-5557
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275074148 | Medicaid | NY |
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 |
|---|---|---|---|
| 021282-1 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1489363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554422400000",
"number": "1275074148",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2176 STATE ROUTE 32",
"city": "MODENA",
"state": "NY",
"postal_code": "125485211",
"telephone_number": "845-514-5557"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2176 STATE ROUTE 32",
"city": "MODENA",
"state": "NY",
"postal_code": "125485211",
"telephone_number": "845-514-5557"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "NICOLE",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-03-13",
"last_updated": "2019-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NY",
"license": "021282-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1275074148",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Modena, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.