Nicole Kubota Lussier, MOT R/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

10590 Issued in CA

Practice address

1120 Via Callejon
Suite B
San Clemente, CA 92673-6213

Phone

(949) 498-5100

NPI assigned

Aug 14, 2009

Last updated

Aug 14, 2009By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Specialty

Occupational Therapist in Private Practice

Education

Loma Linda University School of Medicine, 2008

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1250208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1250208000000",
    "number": "1518199124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 VIA CALLEJON",
            "address_2": "SUITE B",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926736213",
            "telephone_number": "949-498-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 VIA CALLEJON",
            "address_2": "SUITE B",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926736213",
            "telephone_number": "949-498-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUSSIER",
        "first_name": "NICOLE",
        "middle_name": "KUBOTA",
        "name_prefix": "Mrs.",
        "credential": "MOT R/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-14",
        "last_updated": "2009-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CA",
            "license": "10590",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in San Clemente, CA
• Providers in San Clemente, CA by specialty
• Occupational Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.