Active NPI
Traci Jamroga Gleason
- Occupational Therapy Assistant
- Goshen, NY
National Provider Identifier
1699066159
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 006919-1
- Practice address
- 53 Gibson Road
Goshen, NY 10925 - Phone
- (845) 291-0200
- NPI assigned
- May 2, 2011
- 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 | 006919-1 | NY | Primary |
Addresses
Primary practice location
53 Gibson Road
Goshen, NY 10925
Mailing address
132 Olsen CT
Montgomery, NY 12549-1736
Phone (845) 649-5784
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 |
|---|---|---|---|
| 006919-1 | NY | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1304294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1304294400000",
"number": "1699066159",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "132 OLSEN CT",
"city": "MONTGOMERY",
"state": "NY",
"postal_code": "125491736",
"telephone_number": "845-649-5784"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "53 GIBSON ROAD",
"city": "GOSHEN",
"state": "NY",
"postal_code": "10925",
"telephone_number": "845-291-0200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLEASON",
"first_name": "TRACI",
"middle_name": "JAMROGA",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-05-02",
"last_updated": "2011-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "NY",
"license": "006919-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Goshen, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.