Active NPI
Lynn A Salley, OT
- Pediatric Occupational Therapist
- Rockford, IL
National Provider Identifier
1639381064
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- 056.006808
- Practice address
- 5854 Dafred Dr
Rockford, IL 61107-5112 - Phone
- (815) 985-8823
- NPI assigned
- May 6, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 056.006808 | IL | Primary |
Addresses
Primary practice location
5854 Dafred Dr
Rockford, IL 61107-5112
Mailing address
5854 Dafred Dr
Rockford, IL 61107-5112
Phone (815) 985-8823
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 056.006808 | IL | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178409600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464825600000",
"number": "1639381064",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5854 DAFRED DR",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611075112",
"telephone_number": "815-985-8823"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5854 DAFRED DR",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611075112",
"telephone_number": "815-985-8823"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SALLEY",
"first_name": "LYNN",
"middle_name": "A",
"name_prefix": "Ms.",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-06",
"last_updated": "2016-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "IL",
"license": "056.006808",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.