Active NPI
Grace Janine Cooper
- Occupational Therapist
- Traverse City, MI
National Provider Identifier
1619633674
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 5201011388
- Practice address
- 415 Munson Ave
Traverse City, MI 49686-3059 - Phone
- (231) 486-6330
- NPI assigned
- Nov 15, 2021
- 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 | 5201011388 | MI | Primary |
Addresses
Primary practice location
415 Munson Ave
Traverse City, MI 49686-3059
Mailing address
415 Munson Ave
Traverse City, MI 49686-3059
Phone (231) 486-6330
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| FDC921054121 | Other | IL | BLUE CROSS BLUE SHIELD-IL |
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": "1636934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636934400000",
"number": "1619633674",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "415 MUNSON AVE",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496863059",
"telephone_number": "231-486-6330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "415 MUNSON AVE",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496863059",
"telephone_number": "231-486-6330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COOPER",
"first_name": "GRACE",
"middle_name": "JANINE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-11-15",
"last_updated": "2021-11-15",
"certification_date": "2021-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MI",
"license": "5201011388",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD-IL",
"identifier": "FDC921054121",
"state": "IL"
}
],
"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 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.