Active NPI
Mackenzie R Mousouleas, OTR/L
- Occupational Therapist
- Woodhaven, MI
National Provider Identifier
1679110480
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- Practice address
- 21267 Mayfair St
Woodhaven, MI 48183-1609 - Phone
- (734) 672-2933
- NPI assigned
- Dec 1, 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 | Primary |
Addresses
Primary practice location
21267 Mayfair St
Woodhaven, MI 48183-1609
Mailing address
21267 Mayfair St
Woodhaven, MI 48183-1609
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| M242570730993 | Other | MI | STATE ID |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1575158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1575158400000",
"number": "1679110480",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21267 MAYFAIR ST",
"city": "WOODHAVEN",
"state": "MI",
"postal_code": "481831609"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21267 MAYFAIR ST",
"city": "WOODHAVEN",
"state": "MI",
"postal_code": "481831609",
"telephone_number": "734-672-2933"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOUSOULEAS",
"first_name": "MACKENZIE",
"middle_name": "R",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-12-01",
"last_updated": "2019-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE ID",
"identifier": "M242570730993",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Woodhaven, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 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.