Active NPI
Dustin Taylor Hogan
- Occupational Therapist
- Bourbonnais, IL
National Provider Identifier
1306575600
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 056015390
- Practice address
- 424 Anita Dr
Bourbonnais, IL 60914-1072 - Phone
- (405) 761-1165
- NPI assigned
- Jun 10, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 056015390 | IL | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X | IL |
Addresses
Primary practice location
424 Anita Dr
Bourbonnais, IL 60914-1072
Mailing address
424 Anita Dr
Bourbonnais, IL 60914-1072
Phone (405) 761-1165
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 |
|---|---|---|---|
| 056015390 | IL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654819200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684713600000",
"number": "1306575600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "424 ANITA DR",
"city": "BOURBONNAIS",
"state": "IL",
"postal_code": "609141072",
"telephone_number": "405-761-1165"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "424 ANITA DR",
"city": "BOURBONNAIS",
"state": "IL",
"postal_code": "609141072",
"telephone_number": "405-761-1165"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOGAN",
"first_name": "DUSTIN",
"middle_name": "TAYLOR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-06-10",
"last_updated": "2023-05-22",
"certification_date": "2023-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IL",
"license": "056015390",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "IL",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bourbonnais, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.