Active NPI
Glenn Breuker, OTR/L
- Occupational Therapist
- Grand Rapids, MI
National Provider Identifier
1275880353
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 5201002302
- Practice address
- 1471 Grace St SE
Grand Rapids, MI 49506-1678 - Phone
- (616) 913-2006
- Fax
- (616) 913-2005
- NPI assigned
- Aug 8, 2012
- Sex
- Male
- 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 | 5201002302 | MI | Primary |
Addresses
Primary practice location
1471 Grace St SE
Grand Rapids, MI 49506-1678
Mailing address
1471 Grace St SE
Grand Rapids, MI 49506-1678
Phone (616) 913-2006
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
| License | State | Type | Specialty |
|---|---|---|---|
| 5201002302 | MI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1344384000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344384000000",
"number": "1275880353",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1471 GRACE ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495061678",
"telephone_number": "616-913-2006",
"fax_number": "616-913-2005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1471 GRACE ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495061678",
"telephone_number": "616-913-2006",
"fax_number": "616-913-2005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BREUKER",
"first_name": "GLENN",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-08-08",
"last_updated": "2012-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MI",
"license": "5201002302",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.