Active NPI
Miranda Dee Jenkins, OTR
- Occupational Therapist
- Niles, MI
National Provider Identifier
1609588656
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 5201013199
- Practice address
- 31 N Saint Joseph Ave
Niles, MI 49120-2207 - Phone
- (269) 687-1885
- NPI assigned
- Dec 21, 2022
- Sex
- Female
- 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 | 5201013199 | MI | Primary |
Addresses
Primary practice location
31 N Saint Joseph Ave
Niles, MI 49120-2207
Mailing address
31 N Saint Joseph Ave
Niles, MI 49120-2207
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 |
|---|---|---|---|
| 5201013199 | MI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1671580800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1671580800000",
"number": "1609588656",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31 N SAINT JOSEPH AVE",
"city": "NILES",
"state": "MI",
"postal_code": "491202207"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "31 N SAINT JOSEPH AVE",
"city": "NILES",
"state": "MI",
"postal_code": "491202207",
"telephone_number": "269-687-1885"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENKINS",
"first_name": "MIRANDA",
"middle_name": "DEE",
"credential": "OTR",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-12-21",
"last_updated": "2022-12-21",
"certification_date": "2022-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MI",
"license": "5201013199",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Niles, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.