Jessica Ellinger, OTR/L CBIS

Primary specialty

Neurorehabilitation Occupational TherapistTaxonomy code 225XN1300X

License

5201008424 Issued in MI

Practice address

3181 Sandhill Rd
Mason, MI 48854-9425

Phone

(517) 336-6060

Fax

(517) 336-6050

NPI assigned

Apr 14, 2015

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

• Jessica Fluegeman Former name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 8, 2019.

{
    "created_epoch": "1428969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549584000000",
    "number": "1457747685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3181 SANDHILL RD",
            "city": "MASON",
            "state": "MI",
            "postal_code": "488549425",
            "telephone_number": "517-336-6060",
            "fax_number": "517-336-6050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3181 SANDHILL RD",
            "city": "MASON",
            "state": "MI",
            "postal_code": "488549425",
            "telephone_number": "517-336-6060",
            "fax_number": "517-336-6050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLINGER",
        "first_name": "JESSICA",
        "credential": "OTR/L CBIS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-04-14",
        "last_updated": "2019-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XN1300X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Neurorehabilitation",
            "state": "MI",
            "license": "5201008424",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OCCUPATIONAL THERAPIST LICENSE",
            "identifier": "5201008424",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY",
            "identifier": "305197",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "FLUEGEMAN",
            "credential": "OTR/L, CBIS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• All providers in Mason, MI
• Neurorehabilitation Occupational Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 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.

Verify at the official NPI Registry.