Mary Nissen, OTR/L

Primary specialty

SpecialistTaxonomy code 174400000X

License

056-007166 Issued in IL

Practice address

328 N Shaddle Ave
Mundelein, IL 60060-2411

Phone

(847) 566-9860

Fax

(847) 566-9861

NPI assigned

Dec 17, 2009

Last updated

Dec 17, 2009By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Amy Zier & Megan Carrick Pediatric Therapy, LLC

  • Specialist
  • Libertyville, IL
  • NPI 1699966135
  NPD (past)
• Megan Carrick, LLC

  dba Kids-In-Sync

  • Pediatric Occupational Therapist
  • Northfield, IL
  • NPI 1457689002
  NPD (past)

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

{
    "created_epoch": "1261008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1261008000000",
    "number": "1548599707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1932 W CRYSTAL ST",
            "address_2": "UNIT 2",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606223132",
            "telephone_number": "847-784-9115",
            "fax_number": "847-784-9330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "328 N SHADDLE AVE",
            "city": "MUNDELEIN",
            "state": "IL",
            "postal_code": "600602411",
            "telephone_number": "847-566-9860",
            "fax_number": "847-566-9861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISSEN",
        "first_name": "MARY",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-12-17",
        "last_updated": "2009-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "056-007166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Neurobehavioral Health Connections, LTD
• Jackson I Newberry III
• Nina Neyman, M.D.
• Inetta V Nikogosian, DN
• Joann Kendrick Nishimoto, PSY.D.
• North Star Counseling Group, LLC
• Northern Illinois Eye Clinic LLC
• Northern Lights Guidance and Counseling LLC
• Nova Dental Care PLLC
• Karen O'Keeffe, PSY.D.

• Specialist in Mundelein, IL
• Providers in Mundelein, IL by specialty
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2009; 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.