Active NPI
Nicholas Angelo Polydoras, OTR
- Occupational Therapist
- Livonia, MI
National Provider Identifier
1659568129
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 5201005125
- Practice address
- 29510 7 Mile Rd
Livonia, MI 48152-1910 - Phone
- (248) 427-9525
- Fax
- (248) 427-9528
- NPI assigned
- Sep 28, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 5201005125 | MI | Primary |
Addresses
Primary practice location
29510 7 Mile Rd
Livonia, MI 48152-1910
Mailing address
29510 7 Mile Rd
Livonia, MI 48152-1910
Phone (248) 427-9525
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Abilities Pathways, Inc. | Occupational Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190937600000",
"number": "1659568129",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29510 7 MILE RD",
"city": "LIVONIA",
"state": "MI",
"postal_code": "481521910",
"telephone_number": "248-427-9525",
"fax_number": "248-427-9528"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "29510 7 MILE RD",
"city": "LIVONIA",
"state": "MI",
"postal_code": "481521910",
"telephone_number": "248-427-9525",
"fax_number": "248-427-9528"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLYDORAS",
"first_name": "NICHOLAS",
"middle_name": "ANGELO",
"name_prefix": "Mr.",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-09-28",
"last_updated": "2007-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MI",
"license": "5201005125",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Livonia, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.