Active NPI
Nicholas Paul Gerasimoff, OTRL
- Occupational Therapist
- Dearborn, MI
National Provider Identifier
1285932012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 5201007912
- Practice address
- 22731 Newman St Ste 100B
Dearborn, MI 48124-2023 - Phone
- (313) 791-0616
- Fax
- (313) 791-0632
- NPI assigned
- Mar 2, 2011
- Sex
- Male
- Sole proprietor
- Yes
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 | 5201007912 | MI | Primary |
Addresses
Primary practice location
22731 Newman St Ste 100B
Dearborn, MI 48124-2023
Mailing address
12560 Jelso PL
Tecumseh, ONTARIO N8N4H4
CA
Phone (519) 735-1898
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 |
|---|---|---|---|
| 5201007912 | MI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1299024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1299024000000",
"number": "1285932012",
"addresses": [
{
"country_code": "CA",
"country_name": "Canada",
"address_purpose": "MAILING",
"address_type": "FGN",
"address_1": "12560 JELSO PL",
"city": "TECUMSEH",
"state": "ONTARIO",
"postal_code": "N8N4H4",
"telephone_number": "519-735-1898"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22731 NEWMAN ST STE 100B",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481242023",
"telephone_number": "313-791-0616",
"fax_number": "313-791-0632"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GERASIMOFF",
"first_name": "NICHOLAS",
"middle_name": "PAUL",
"credential": "OTRL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-03-02",
"last_updated": "2011-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MI",
"license": "5201007912",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dearborn, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.