Individual provider Active NPI

Nichole Roost, OTR/L

  • Hand Occupational Therapist
  • Traverse City, MI
National Provider Identifier
1548656366
Registry record updated Apr 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hand Occupational TherapistTaxonomy code 225XH1200X
License
5201011112 Issued in MI
Practice address
4110 Copper Ridge Dr Ste 204D
Traverse City, MI 49684-6721
Phone
(231) 300-8411
NPI assigned
Apr 8, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hand Occupational Therapist 225XH1200X 5201011112 MI Primary

Addresses

Primary practice location

4110 Copper Ridge Dr Ste 204D
Traverse City, MI 49684-6721

Mailing address

4110 Copper Ridge Dr Ste 204D
Traverse City, MI 49684-6721
Phone (231) 300-8411

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220813000544 MI Practitioner - Occupational Therapist in Private Practice 1456658897 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
15181CAMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
Bayshore Hand Rehabilitation Hand CurrentSince Mar 18, 2024 Accepting new patients
Hand Surgery of Northern Michigan PLC Hand CurrentSince Aug 2, 2022 Accepting new patients
Hand Surgery of Northern Michigan PLC CurrentSince Aug 2, 2022 Accepting new patients

Locations

701 W Front St
Ste 100
Traverse City, MI 49684
Phone (231) 935-0800

4110 Copper Ridge Dr
Ste 204D
Traverse City, MI 49684
Phone (231) 300-8411

Organizations & group practices 3

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": "1428451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713744000000",
    "number": "1548656366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4110 COPPER RIDGE DR STE 204D",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496846721",
            "telephone_number": "231-300-8411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4110 COPPER RIDGE DR STE 204D",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496846721",
            "telephone_number": "231-300-8411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROOST",
        "first_name": "NICHOLE",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-08",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XH1200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Hand",
            "state": "MI",
            "license": "5201011112",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.