Individual provider Active NPI

Alicia Jean Sheeran, PTA, COTA

  • Physical Therapy Assistant
  • Grand Rapids, MI
National Provider Identifier
1679820757
Registry record updated Aug 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
5502002799 Issued in MI
Practice address
1471 Grace St SE
Grand Rapids, MI 49506-1678
Phone
(616) 913-2006
Fax
(616) 913-2005
NPI assigned
Aug 8, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 5202006980 MI
Physical Therapy Assistant 225200000X 5502002799 MI Primary

Addresses

Primary practice location

1471 Grace St SE
Grand Rapids, MI 49506-1678

Mailing address

1471 Grace St SE
Grand Rapids, MI 49506-1678
Phone (616) 913-2006

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

LicenseStateTypeSpecialty
5202006980MIMDOccupational Therapy Assistant
5502002799MIMDPhysical Therapy Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344384000000",
    "number": "1679820757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1471 GRACE ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495061678",
            "telephone_number": "616-913-2006",
            "fax_number": "616-913-2005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1471 GRACE ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495061678",
            "telephone_number": "616-913-2006",
            "fax_number": "616-913-2005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEERAN",
        "first_name": "ALICIA",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "PTA, COTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-08",
        "last_updated": "2012-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "MI",
            "license": "5202006980",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MI",
            "license": "5502002799",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.