NPIMap

Individual provider Active NPI

Michele K Moore, OT

  • Occupational Therapist
  • Harvard, IL
National Provider Identifier
1306157250
Registry record updated Oct 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
056-009055 Issued in IL
Practice address
901 Grant St
Harvard, IL 60033-1821
Phone
(815) 943-2975
Fax
(815) 943-5470
NPI assigned
Jun 25, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2013

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 056-009055 IL Primary

Addresses

Primary practice location

901 Grant St
Harvard, IL 60033-1821

Mailing address

901 Grant St
Harvard, IL 60033-1821
Phone (815) 943-2975

Other names 1

  • Michele Johnson Former name

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
056-009055ILMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Accelerated Rehabilitation Centers LTD Occupational Therapist Past Accepting new patients
Accelerated Rehabilitation Centers, LTD Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1277424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1382313600000",
    "number": "1306157250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 GRANT ST",
            "city": "HARVARD",
            "state": "IL",
            "postal_code": "600331821",
            "telephone_number": "815-943-2975",
            "fax_number": "815-943-5470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 GRANT ST",
            "city": "HARVARD",
            "state": "IL",
            "postal_code": "600331821",
            "telephone_number": "815-943-2975",
            "fax_number": "815-943-5470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MICHELE",
        "middle_name": "K",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-25",
        "last_updated": "2013-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056-009055",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELE",
            "last_name": "JOHNSON",
            "credential": "OT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Harvard, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 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.