Active NPI
Kristen Macy
- Occupational Therapist
- Fort Wayne, IN
National Provider Identifier
1669939864
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 31004953A
- Practice address
- 201 E Rudisill Blvd Ste 301
Fort Wayne, IN 46806-1756 - Phone
- (260) 348-9887
- NPI assigned
- Feb 23, 2019
- 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 | 31004953A | IN | Primary |
Addresses
Primary practice location
201 E Rudisill Blvd Ste 301
Fort Wayne, IN 46806-1756
Mailing address
3384 Riders TRL
Fort Wayne, IN 46814-0005
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 |
|---|---|---|---|
| 31004953A | IN | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1550880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550880000000",
"number": "1669939864",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3384 RIDERS TRL",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468140005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 E RUDISILL BLVD STE 301",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468061756",
"telephone_number": "260-348-9887"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACY",
"first_name": "KRISTEN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-02-23",
"last_updated": "2019-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IN",
"license": "31004953A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.