Individual provider Active NPI

Camryn Stasulas, OTD, OTR/L

  • Occupational Therapist
  • Mokena, IL
National Provider Identifier
1376351270
Registry record updated Dec 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
056.016370 Issued in IL
Practice address
19100 Crescent Dr Ste 101
Mokena, IL 60448-7526
Phone
(708) 478-5400
NPI assigned
Dec 23, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2024

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 056.016370 IL Primary

Addresses

Primary practice location

19100 Crescent Dr Ste 101
Mokena, IL 60448-7526

Mailing address

1344 E Lyn CT
Homewood, IL 60430-3834
Phone (708) 205-8622

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
056.016370ILMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Kids Can DO, Inc. Occupational Therapist PastSince Dec 29, 2024 Accepting new patients

Organizations & group practices 1

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": "1734912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734912000000",
    "number": "1376351270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1344 E LYN CT",
            "city": "HOMEWOOD",
            "state": "IL",
            "postal_code": "604303834",
            "telephone_number": "708-205-8622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19100 CRESCENT DR STE 101",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604487526",
            "telephone_number": "708-478-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STASULAS",
        "first_name": "CAMRYN",
        "credential": "OTD, OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-23",
        "last_updated": "2024-12-23",
        "certification_date": "2024-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056.016370",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mokena, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2024; 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.