NPIMap

Individual provider Active NPI

Amanda Elizabeth Smith, MS, OTRL

  • Occupational Therapist
  • Dearborn, MI
National Provider Identifier
1467880971
Registry record updated Sep 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
5201008628 Issued in MI
Practice address
18501 Rotunda Dr Ste 100
Dearborn, MI 48124-3891
Phone
(313) 996-1949
NPI assigned
Oct 18, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 12, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 5201008628 MI Primary
Pediatric Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225XP0200X 5201008628 MI

Addresses

Primary practice location

18501 Rotunda Dr Ste 100
Dearborn, MI 48124-3891

Mailing address

18501 Rotunda Dr Ste 100
Dearborn, MI 48124-3891
Phone (313) 996-1930

Other practice location 1

14769 Old Town Ct
Riverview, MI 48193-7710
Phone (313) 418-0414

Other names 1

  • Amanda Elizabeth Theisen Former name

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
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
5201008628MIMDPediatric Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Beaumont Medical Group- Specialty Services Multi-Specialty Past Accepting new patients
Oakwood Healthcare Inc Multi-Specialty Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1382054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536710400000",
    "number": "1467880971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18501 ROTUNDA DR STE 100",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481243891",
            "telephone_number": "313-996-1930",
            "fax_number": "313-996-1935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18501 ROTUNDA DR STE 100",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481243891",
            "telephone_number": "313-996-1949"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14769 Old Town Ct",
            "address_purpose": "LOCATION",
            "city": "Riverview",
            "state": "MI",
            "postal_code": "481937710",
            "country_code": "US",
            "telephone_number": "313-418-0414",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "AMANDA",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "MS, OTRL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-10-18",
        "last_updated": "2018-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MI",
            "license": "5201008628",
            "primary": true
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "MI",
            "license": "5201008628",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "THEISEN",
            "middle_name": "ELIZABETH",
            "credential": "MS, OTRL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Dearborn, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2018; 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.