Active NPI
Dominador Randy Burtanog
- Occupational Therapist
- Fall River, MA
National Provider Identifier
1609219823
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 8619
- Practice address
- 27 Courtney St
Apt. 8
Fall River, MA 02720-6706 - Phone
- (401) 316-4201
- NPI assigned
- Apr 8, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 8619 | MA | Primary |
Addresses
Primary practice location
27 Courtney St
Apt. 8
Fall River, MA 02720-6706
Mailing address
27 Courtney St
Apt. 8
Fall River, MA 02720-6706
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8619 | MA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1365379200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365379200000",
"number": "1609219823",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "27 COURTNEY ST",
"address_2": "APT. 8",
"city": "FALL RIVER",
"state": "MA",
"postal_code": "027206706"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "27 COURTNEY ST",
"address_2": "APT. 8",
"city": "FALL RIVER",
"state": "MA",
"postal_code": "027206706",
"telephone_number": "401-316-4201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURTANOG",
"first_name": "DOMINADOR",
"middle_name": "RANDY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-04-08",
"last_updated": "2013-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MA",
"license": "8619",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fall River, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.