Individual provider Active NPI

Michelle Mary Keane-Taylor, COTA/L

  • Occupational Therapy Assistant
  • Enfield, CT
National Provider Identifier
1386048007
Registry record updated Oct 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
000568 Issued in CT
Practice address
1157 Enfield Street
Kindred Healthcare @ Parkway Pavilion
Enfield, CT 06082
Phone
(860) 745-1641
NPI assigned
Oct 9, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 000568 CT Primary
Occupational Therapy Assistant 224Z00000X 2808 MA

Addresses

Primary practice location

1157 Enfield Street
Kindred Healthcare @ Parkway Pavilion
Enfield, CT 06082

Mailing address

19 Prospect HTS
Stafford Springs, CT 06076-1112
Phone (860) 573-7017

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
000568CTMDAddiction (Substance Use Disorder) Counselor
2808MAMDOccupational Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1412812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412812800000",
    "number": "1386048007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 PROSPECT HTS",
            "city": "STAFFORD SPRINGS",
            "state": "CT",
            "postal_code": "060761112",
            "telephone_number": "860-573-7017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1157 ENFIELD STREET",
            "address_2": "KINDRED HEALTHCARE @ PARKWAY PAVILION",
            "city": "ENFIELD",
            "state": "CT",
            "postal_code": "06082",
            "telephone_number": "860-745-1641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEANE-TAYLOR",
        "first_name": "MICHELLE",
        "middle_name": "MARY",
        "credential": "COTA/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-09",
        "last_updated": "2014-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "CT",
            "license": "000568",
            "primary": true
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "MA",
            "license": "2808",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Enfield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2014; 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.