Mitzi Michelle Cleary, OTD, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

2003000911 Issued in MO

Practice address

18939 Evergreen Dr
Country Club, MO 64505-4058

Phone

(816) 279-3020

Fax

(816) 279-3094

NPI assigned

Sep 13, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Mrs. Mitzi Michelle Woods Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291680000000",
    "number": "1407951791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18939 EVERGREEN DR",
            "city": "COUNTRY CLUB",
            "state": "MO",
            "postal_code": "645054058",
            "telephone_number": "816-279-3020",
            "fax_number": "816-279-3094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18939 EVERGREEN DR",
            "city": "COUNTRY CLUB",
            "state": "MO",
            "postal_code": "645054058",
            "telephone_number": "816-279-3020",
            "fax_number": "816-279-3094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEARY",
        "first_name": "MITZI",
        "middle_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "credential": "OTD, OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-13",
        "last_updated": "2010-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MO",
            "license": "2003000911",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "KS",
            "license": "17-02329",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPLOYMENT IDENTIFICATION NUMBER",
            "identifier": "711037536",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MITZI",
            "last_name": "WOODS",
            "middle_name": "MICHELLE",
            "prefix": "MRS.",
            "credential": "OTD, OTR/L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sara Elise Amos, RN, IBCLC
• Mitzi M. Cleary, Otd, Otr/L, Inc.
• Jaclyn Renee' Powell
• James Dale Schoonover, DC
• Christina Semenchuk, LCSW
• Karley Jo Smith, MA, CF-SLP

• Occupational Therapist in Country Club, MO
• Providers in Country Club, MO by specialty
• Occupational Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2010; 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.