Mary Elizabeth Nordgulen, OTR/L, C4T

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT1844 Issued in FL

Practice address

307 Boatner Road
96TH MDG
Eglin Afb, FL 32542

Phone

(850) 883-8314

Fax

(334) 836-2247

NPI assigned

Dec 9, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1134086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318809600000",
    "number": "1316922552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 BOATNER ROAD",
            "address_2": "96TH MDG",
            "city": "EGLIN AFB",
            "state": "FL",
            "postal_code": "32542",
            "telephone_number": "850-883-8314",
            "fax_number": "334-836-2247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 BOATNER ROAD",
            "address_2": "96TH MDG",
            "city": "EGLIN AFB",
            "state": "FL",
            "postal_code": "32542",
            "telephone_number": "850-883-8314",
            "fax_number": "334-836-2247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NORDGULEN",
        "first_name": "MARY",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "OTR/L, C4T",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-09",
        "last_updated": "2011-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "AL",
            "license": "2098",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "FL",
            "license": "OT1844",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891009320",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891009330",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891009340",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Zachary Newcomer
• Stephanie Nicole Newman, IDMT
• William L Newman, IDMT
• Jason T. Nieves, MD
• Bonnie Gillis Nolan, MD
• Dennis A Nutter Jr., MD
• Erin O'Connor, DPT
• Thomas J O'Connor, DMD
• Elise Marie Ocelnik, PHD
• Kimberly Offhaus, ARNP

• Occupational Therapist in Eglin Afb, FL
• Providers in Eglin Afb, FL by specialty
• Occupational Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2011; 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.