Active NPI
Mmesoma G Okonkwo
- Occupational Therapist
- Charlotte, NC
National Provider Identifier
1700613734
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 16697
- Practice address
- 9200 Glenwater Dr
Charlotte, NC 28262-8557 - Phone
- (704) 549-0807
- Fax
- (704) 548-8413
- NPI assigned
- Sep 16, 2024
- 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 Therapist | 225X00000X | 16697 | NC | Primary |
Addresses
Primary practice location
9200 Glenwater Dr
Charlotte, NC 28262-8557
Mailing address
5603 Graypark Dr
Charlotte, NC 28269-5751
Phone (980) 250-4664
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 |
|---|---|---|---|
| 16697 | NC | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1726444800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726444800000",
"number": "1700613734",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5603 GRAYPARK DR",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282695751",
"telephone_number": "980-250-4664"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9200 GLENWATER DR",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282628557",
"telephone_number": "704-549-0807",
"fax_number": "704-548-8413"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OKONKWO",
"first_name": "MMESOMA",
"middle_name": "G",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-09-16",
"last_updated": "2024-09-16",
"certification_date": "2024-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NC",
"license": "16697",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.