Individual provider Active NPI

Caitlin Demuth

  • Pediatric Occupational Therapist
  • Fort Wayne, IN
National Provider Identifier
1346735743
Registry record updated Oct 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
License
31006656A Issued in IN
Practice address
4935 Hillegas Rd
Fort Wayne, IN 46818-1934
Phone
(260) 338-1241
NPI assigned
Jun 27, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Occupational Therapist 225XP0200X 31006656A IN Primary

Addresses

Primary practice location

4935 Hillegas Rd
Fort Wayne, IN 46818-1934

Mailing address

10 S 9TH St
Ste 4
Noblesville, IN 46060-2631
Phone (765) 524-3946

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201007003403 IN Practitioner - Occupational Therapist in Private Practice 9739508904 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Creative Health Care Management LLC CurrentSince Oct 1, 2020 Accepting new patients
Creative Health Care Management LLC CurrentSince Oct 1, 2020 Accepting new patients
Possibilities Northeast, LLC. Past Accepting new patients

Locations

300 E Washington Blvd
Fort Wayne, IN 46802
Phone (260) 422-5511

10 S 9th St
Ste 4
Noblesville, IN 46060

Organizations & group practices 3

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": "1530057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601942400000",
    "number": "1346735743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 S 9TH ST",
            "address_2": "STE 4",
            "city": "NOBLESVILLE",
            "state": "IN",
            "postal_code": "460602631",
            "telephone_number": "765-524-3946",
            "fax_number": "317-708-6496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4935 HILLEGAS RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468181934",
            "telephone_number": "260-338-1241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMUTH",
        "first_name": "CAITLIN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-27",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "IN",
            "license": "31006656A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.