Active NPI
Samuel John Penkala, OTRL
- Occupational Therapist
- Midland, MI
National Provider Identifier
1487143533
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 5201009388
- Practice address
- 304 W Wackerly St Ste 500
Midland, MI 48640-7264 - Phone
- (989) 832-4220
- Fax
- (989) 832-4207
- NPI assigned
- May 4, 2018
- Last updated
- May 4, 2018
- Sex
- Male
- 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 | 5201009388 | MI | Primary |
Addresses
Primary practice location
304 W Wackerly St Ste 500
Midland, MI 48640-7264
Mailing address
304 W Wackerly St Ste 500
Midland, MI 48640-7264
Phone (989) 832-4220
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 |
|---|---|---|---|
| 5201009388 | MI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1525392000000",
"number": "1487143533",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "304 W WACKERLY ST STE 500",
"city": "MIDLAND",
"state": "MI",
"postal_code": "486407264",
"telephone_number": "989-832-4220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "304 W WACKERLY ST STE 500",
"city": "MIDLAND",
"state": "MI",
"postal_code": "486407264",
"telephone_number": "989-832-4220",
"fax_number": "989-832-4207"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENKALA",
"first_name": "SAMUEL",
"middle_name": "JOHN",
"credential": "OTRL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-05-04",
"last_updated": "2018-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MI",
"license": "5201009388",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Midland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 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.