Jesse Bryan Nicodemus, MOT

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

201009340 Issued in MI

Practice address

2320 E Beltline Ave SE
Grand Rapids, MI 49546-5906

Phone

(616) 831-8666

NPI assigned

Nov 28, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1543363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543363200000",
    "number": "1386114734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2320 E BELTLINE AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495465906",
            "telephone_number": "616-831-8666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2320 E BELTLINE AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495465906",
            "telephone_number": "616-831-8666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICODEMUS",
        "first_name": "JESSE",
        "middle_name": "BRYAN",
        "credential": "MOT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-11-28",
        "last_updated": "2018-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "MI",
            "license": "201009340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa K Nicholson, LMSW
• Tarah Nicholson, DPT
• Ashley Nickell, PA-C
• Jack Philip Nickerson, CRNA
• Robert J Nickerson, PTA
• Sonia Nicola
• Lillian Ann Nicolas
• Nicole L Nicolas, MS, CCC-SLP
• Malea Nicolet, LLPC
• Nicholas William Nicoletti

• Occupational Therapist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Occupational Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2018; 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.