Active NPI
Michele Adele Lum, COTA
- Occupational Therapy Assistant
- Canton, OH
National Provider Identifier
1710204623
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 04198
- Practice address
- 800 Market Ave N
Canton, OH 44702-1083 - Phone
- (330) 430-2119
- NPI assigned
- May 1, 2010
- 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 | 04198 | OH | Primary |
Addresses
Primary practice location
800 Market Ave N
Canton, OH 44702-1083
Mailing address
800 Market Ave N
Canton, OH 44702-1083
Phone (330) 430-2119
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0040036472E | Other | OH | AULTCARE |
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 |
|---|---|---|---|
| 04198 | OH | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1272672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1272672000000",
"number": "1710204623",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 MARKET AVE N",
"city": "CANTON",
"state": "OH",
"postal_code": "447021083",
"telephone_number": "330-430-2119"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 MARKET AVE N",
"city": "CANTON",
"state": "OH",
"postal_code": "447021083",
"telephone_number": "330-430-2119"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUM",
"first_name": "MICHELE",
"middle_name": "ADELE",
"name_prefix": "Mrs.",
"credential": "COTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-05-01",
"last_updated": "2010-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "OH",
"license": "04198",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AULTCARE",
"identifier": "0040036472E",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Canton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.