NPIMap

Individual provider Active NPI

Corey R Vanderwulp, OT

  • Occupational Therapist
  • Traverse City, MI
National Provider Identifier
1558606830
Registry record updated Nov 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
5201004911 Issued in MI
Practice address
1650 Barlow St
Traverse City, MI 49686-4721
Phone
(231) 941-3100
Fax
(231) 922-0382
NPI assigned
Nov 28, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 5201004911 MI Primary

Addresses

Primary practice location

1650 Barlow St
Traverse City, MI 49686-4721

Mailing address

1650 Barlow St
Traverse City, MI 49686-4721
Phone (231) 941-3100

Other identifiers 1

IdentifierTypeStateIssuer
43-2035142OtherMIGLTHC TAX ID

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)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1354060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354060800000",
    "number": "1558606830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 BARLOW ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496864721",
            "telephone_number": "231-941-3100",
            "fax_number": "231-922-0382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 BARLOW ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496864721",
            "telephone_number": "231-941-3100",
            "fax_number": "231-922-0382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERWULP",
        "first_name": "COREY",
        "middle_name": "R",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-11-28",
        "last_updated": "2012-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MI",
            "license": "5201004911",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GLTHC TAX ID",
            "identifier": "43-2035142",
            "state": "MI"
        }
    ],
    "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 Nov 28, 2012; 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.