Active NPI
Susan Mack, OTR/L
- Pediatric Occupational Therapist
- Chesapeake, VA
National Provider Identifier
1356596217
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- 0119004459
- Practice address
- 4016 Raintree Rd
Suite 240
Chesapeake, VA 23321-3700 - Phone
- (757) 488-2864
- Fax
- (757) 488-4735
- NPI assigned
- Nov 19, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 0119004459 | VA | Primary |
Addresses
Primary practice location
4016 Raintree Rd
Suite 240
Chesapeake, VA 23321-3700
Mailing address
4016 Raintree Rd
Suite 240
Chesapeake, VA 23321-3700
Phone (757) 488-2864
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004979061 | Medicaid | VA |
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 |
|---|---|---|---|
| 0119004459 | VA | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1227052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1227052800000",
"number": "1356596217",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4016 RAINTREE RD",
"address_2": "SUITE 240",
"city": "CHESAPEAKE",
"state": "VA",
"postal_code": "233213700",
"telephone_number": "757-488-2864",
"fax_number": "757-488-4735"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4016 RAINTREE RD",
"address_2": "SUITE 240",
"city": "CHESAPEAKE",
"state": "VA",
"postal_code": "233213700",
"telephone_number": "757-488-2864",
"fax_number": "757-488-4735"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACK",
"first_name": "SUSAN",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-11-19",
"last_updated": "2008-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "VA",
"license": "0119004459",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004979061",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chesapeake, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.