Active NPI
Stacy Bommelje, COTA/L
- Occupational Therapy Assistant
- Lansing, MI
National Provider Identifier
1437579646
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 5202007780
- Practice address
- 731 Starkweather Dr
Lansing, MI 48917-1128 - Phone
- (517) 323-9133
- Fax
- (517) 323-0092
- NPI assigned
- Apr 27, 2014
- Sex
- Female
- 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 Therapy Assistant | 224Z00000X | 5202007780 | MI | Primary |
Addresses
Primary practice location
731 Starkweather Dr
Lansing, MI 48917-1128
Mailing address
731 Starkweather Dr
Lansing, MI 48917-1128
Phone (517) 323-9133
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
| License | State | Type | Specialty |
|---|---|---|---|
| 5202007780 | MI | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1398556800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398556800000",
"number": "1437579646",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "731 STARKWEATHER DR",
"city": "LANSING",
"state": "MI",
"postal_code": "489171128",
"telephone_number": "517-323-9133",
"fax_number": "517-323-0092"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "731 STARKWEATHER DR",
"city": "LANSING",
"state": "MI",
"postal_code": "489171128",
"telephone_number": "517-323-9133",
"fax_number": "517-323-0092"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOMMELJE",
"first_name": "STACY",
"credential": "COTA/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-04-27",
"last_updated": "2014-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "MI",
"license": "5202007780",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lansing, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 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.