Individual provider Active NPI

Alexandra Elaine Ferguson, OTD, OTR

  • Occupational Therapist
  • Dekalb, IL
National Provider Identifier
1295388254
Registry record updated Jul 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
31006884A Issued in IN
Practice address
1212 S 2ND St
Dekalb, IL 60115-4435
Phone
(815) 758-8151
NPI assigned
Jul 18, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 18, 2019

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 31006884A IN Primary

Addresses

Primary practice location

1212 S 2ND St
Dekalb, IL 60115-4435

Mailing address

6216 Brokenhurst Rd
Indianapolis, IN 46220-4932

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
31006884AINMDOccupational Therapist

NPI Registry JSON

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

{
    "created_epoch": "1563408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563408000000",
    "number": "1295388254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6216 BROKENHURST RD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462204932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1212 S 2ND ST",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601154435",
            "telephone_number": "815-758-8151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERGUSON",
        "first_name": "ALEXANDRA",
        "middle_name": "ELAINE",
        "credential": "OTD, OTR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-18",
        "last_updated": "2019-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IN",
            "license": "31006884A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dekalb, IL

Sources for this page

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

Verify at the official NPI Registry.