Active NPI
Mary Jane Kelly, COTA
- Occupational Therapy Assistant
- Burr Ridge, IL
National Provider Identifier
1689828857
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 057001875
- Practice address
- 6801 High Grove Blvd
Burr Ridge, IL 60527-7585 - Phone
- (630) 734-4588
- Fax
- (630) 920-2453
- NPI assigned
- Nov 13, 2008
- 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 |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 057001875 | IL | Primary |
Addresses
Primary practice location
6801 High Grove Blvd
Burr Ridge, IL 60527-7585
Mailing address
6801 High Grove Blvd
Burr Ridge, IL 60527-7585
Phone (630) 734-4588
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 |
|---|---|---|---|
| 057001875 | IL | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1226534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1226534400000",
"number": "1689828857",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6801 HIGH GROVE BLVD",
"city": "BURR RIDGE",
"state": "IL",
"postal_code": "605277585",
"telephone_number": "630-734-4588",
"fax_number": "630-920-2453"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6801 HIGH GROVE BLVD",
"city": "BURR RIDGE",
"state": "IL",
"postal_code": "605277585",
"telephone_number": "630-734-4588",
"fax_number": "630-920-2453"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "MARY JANE",
"name_prefix": "Ms.",
"credential": "COTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-11-13",
"last_updated": "2008-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "IL",
"license": "057001875",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burr Ridge, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.