Jaclyn Marie Anderson, OT

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

5201005612 Issued in MI

Practice address

124 W Fourth St
Suttons Bay, MI 49682-9733

Phone

(231) 271-1200

Fax

(231) 271-1214

NPI assigned

Sep 7, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Great Lakes Therapy House Calls PC

  • Physical Therapist
  • Traverse City, MI
  • NPI 1649480674
  NPD (past)
• Great Lakes Therapy Housecalls, P.C.

  • Rehabilitation Clinic/Center
  • Traverse City, MI
  • NPI 1093069734
  NPD (past)

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

{
    "created_epoch": "1189123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1382918400000",
    "number": "1295920726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2830 S PINE MEADOW PATH",
            "city": "SUTTONS BAY",
            "state": "MI",
            "postal_code": "496829740",
            "telephone_number": "231-218-2302",
            "fax_number": "231-271-1214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 W FOURTH ST",
            "city": "SUTTONS BAY",
            "state": "MI",
            "postal_code": "496829733",
            "telephone_number": "231-271-1200",
            "fax_number": "231-271-1214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "JACLYN",
        "middle_name": "MARIE",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-07",
        "last_updated": "2013-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MI",
            "license": "5201005612",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "43-2035142",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristen Mary Alway
• Brittany Lyn Bahle, PA-C
• Jennie Maria Baker, PT, DPT
• Arica Bartz, PT, DPT
• Baybrooke Counseling
• Andrea S Becker, OD

• Occupational Therapist in Suttons Bay, MI
• Providers in Suttons Bay, MI by specialty
• Occupational Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2013; 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.