Individual provider Active NPI

Mary Catherine Lodde, OTR L

  • Occupational Therapist
  • Canton, GA
National Provider Identifier
1336218767
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OT002757 Issued in GA
Practice address
1 McGarity Rd
Canton, GA 30115
Phone
(770) 360-9183
Fax
(770) 360-8965
NPI assigned
Nov 7, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 OT002757 GA Primary

Addresses

Primary practice location

1 McGarity Rd
Canton, GA 30115

Mailing address

3539 Sunderland Cir NE
Atlanta, GA 30319-1977
Phone (678) 530-9518

Other identifiers 1

IdentifierTypeStateIssuer
52212658-001OtherGABLUE CROSS BLUE SHIELD

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

LicenseStateTypeSpecialty
OT002757GAMDOccupational Therapist

NPI Registry JSON

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1336218767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3539 SUNDERLAND CIR NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303191977",
            "telephone_number": "678-530-9518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MCGARITY RD",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "30115",
            "telephone_number": "770-360-9183",
            "fax_number": "770-360-8965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LODDE",
        "first_name": "MARY",
        "middle_name": "CATHERINE",
        "name_prefix": "Mrs.",
        "credential": "OTR  L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "GA",
            "license": "OT002757",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "52212658-001",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.