Active NPI
Stephanie Martin, MSOT, OTR
- Occupational Therapist
- South Bend, IN
National Provider Identifier
1457675910
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 056008874
- Practice address
- 1430 E Madison St
South Bend, IN 46617-2427 - Phone
- (617) 308-6461
- Fax
- (617) 308-6461
- NPI assigned
- Mar 26, 2010
- Last updated
- Oct 5, 2015
- 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 Therapist | 225X00000X | 056008874 | IL | Primary |
Addresses
Primary practice location
1430 E Madison St
South Bend, IN 46617-2427
Mailing address
1430 E Madison St
South Bend, IN 46617-2427
Phone (617) 308-6461
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 |
|---|---|---|---|
| 056008874 | IL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1269561600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1444003200000",
"number": "1457675910",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1430 E MADISON ST",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466172427",
"telephone_number": "617-308-6461",
"fax_number": "617-308-6461"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1430 E MADISON ST",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466172427",
"telephone_number": "617-308-6461",
"fax_number": "617-308-6461"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "STEPHANIE",
"credential": "MSOT, OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-03-26",
"last_updated": "2015-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IL",
"license": "056008874",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.