Active NPI
Grace Justice
- Recreation Therapist
- Royal Oak, MI
National Provider Identifier
1295576981
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Recreation Therapist
- License
- 87203
- Practice address
- 520 S Kenwood Ave
Royal Oak, MI 48067-3995 - Phone
- (513) 602-6085
- NPI assigned
- Jun 5, 2024
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | 87203 | MI | Primary |
Addresses
Primary practice location
520 S Kenwood Ave
Royal Oak, MI 48067-3995
Mailing address
520 S Kenwood Ave
Royal Oak, MI 48067-3995
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 |
|---|---|---|---|
| 87203 | MI | MD | Recreation Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1717545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717545600000",
"number": "1295576981",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "520 S KENWOOD AVE",
"city": "ROYAL OAK",
"state": "MI",
"postal_code": "480673995"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "520 S KENWOOD AVE",
"city": "ROYAL OAK",
"state": "MI",
"postal_code": "480673995",
"telephone_number": "513-602-6085"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JUSTICE",
"first_name": "GRACE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-06-05",
"last_updated": "2024-06-05",
"certification_date": "2024-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "225800000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Recreation Therapist",
"state": "MI",
"license": "87203",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Royal Oak, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.