Deandra Mugnolo, OT

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

056012723 Issued in IL

Practice address

1845 Oak St Ste 15
Northfield, IL 60093-3022

Phone

(847) 386-6560

NPI assigned

Oct 24, 2018

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

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Kick Start

  • Occupational Therapist
  • Northfield, IL
  • NPI 1508154212
  NPD (past)

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

{
    "created_epoch": "1540339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540339200000",
    "number": "1528535903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1845 OAK ST STE 15",
            "city": "NORTHFIELD",
            "state": "IL",
            "postal_code": "600933022",
            "telephone_number": "847-386-6560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1845 OAK ST STE 15",
            "city": "NORTHFIELD",
            "state": "IL",
            "postal_code": "600933022",
            "telephone_number": "847-386-6560"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14044 W Petronella Dr Ste 1",
            "address_purpose": "LOCATION",
            "city": "Libertyville",
            "state": "IL",
            "postal_code": "600489656",
            "country_code": "US",
            "telephone_number": "847-386-6560",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MUGNOLO",
        "first_name": "DEANDRA",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-24",
        "last_updated": "2018-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056012723",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsey Lynn Mora, CCLS, LCPC
• Camilo Morales Hormiga
• Kathryn Moreno
• Alexander Morrill, M.D.
• Angela Ak Muganwa
• Somer Rae Muhs
• Anjum Mujahid, MD
• Margaret Kathryn Munce
• Erin Murdoch
• Ana Marissa Murillo Zavala, MS

• Occupational Therapist in Northfield, IL
• Providers in Northfield, IL by specialty
• Occupational Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 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.