Active NPI
Audra Shoemaker
- Occupational Therapist
- Grand Blanc, MI
National Provider Identifier
1720444102
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 5201003096
- Practice address
- 12787 S Saginaw St
Suite C4
Grand Blanc, MI 48439-1830 - Phone
- (810) 771-7631
- Fax
- (810) 771-7976
- NPI assigned
- Jan 14, 2016
- Last updated
- Jan 14, 2016
- 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 | 5201003096 | MI | Primary |
Addresses
Primary practice location
12787 S Saginaw St
Suite C4
Grand Blanc, MI 48439-1830
Mailing address
790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2223
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5201003096 | MI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1452729600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1452729600000",
"number": "1720444102",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "790 REMINGTON BLVD",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604404909",
"telephone_number": "630-296-2223"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12787 S SAGINAW ST",
"address_2": "SUITE C4",
"city": "GRAND BLANC",
"state": "MI",
"postal_code": "484391830",
"telephone_number": "810-771-7631",
"fax_number": "810-771-7976"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHOEMAKER",
"first_name": "AUDRA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-01-14",
"last_updated": "2016-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MI",
"license": "5201003096",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Blanc, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.