Active NPI
Justin Nelson, OTD, OTR/L, LAT, ATC
- Occupational Therapist
- Decatur, IL
National Provider Identifier
1396381554
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- Practice address
- 1415 W Mound Rd
Decatur, IL 62526-1263 - Phone
- (217) 615-3741
- NPI assigned
- Nov 22, 2019
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | Primary |
Addresses
Primary practice location
1415 W Mound Rd
Decatur, IL 62526-1263
Mailing address
1536 S Douglas Ave
Springfield, IL 62704-3516
Other practice location 1
875 W McKinley Ave
Decatur, IL 62526-3287
Phone (217) 872-1282
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1574380800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1574380800000",
"number": "1396381554",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1536 S DOUGLAS AVE",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627043516"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1415 W MOUND RD",
"city": "DECATUR",
"state": "IL",
"postal_code": "625261263",
"telephone_number": "217-615-3741"
}
],
"practiceLocations": [
{
"address_1": "875 W McKinley Ave",
"address_purpose": "LOCATION",
"city": "Decatur",
"state": "IL",
"postal_code": "625263287",
"country_code": "US",
"telephone_number": "217-872-1282",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NELSON",
"first_name": "JUSTIN",
"credential": "OTD, OTR/L, LAT, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-11-22",
"last_updated": "2019-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Decatur, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.