Individual provider Active NPI

Michael Kennison, OT

  • Occupational Therapist
  • North Palm Beach, FL
National Provider Identifier
1720880636
Registry record updated Mar 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
22687 Issued in FL
Practice address
1909 Wheeler Rd Apt B
North Palm Beach, FL 33408-2870
Phone
(314) 374-9681
NPI assigned
Mar 24, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 22687 FL Primary

Addresses

Primary practice location

1909 Wheeler Rd Apt B
North Palm Beach, FL 33408-2870

Mailing address

1909 Wheeler Rd Apt B
North Palm Beach, FL 33408-2870
Phone (314) 374-9681

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250822003406 FL Practitioner - Occupational Therapist in Private Practice 5193225282 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2021
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

21005 NE 19TH CT
N Miami Beach, FL 33179-1511

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
22687FLMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Sobe Innovative Rehabilitation PLLC Occupational Therapist CurrentSince Jun 8, 2025 Accepting new patients

Locations

2777 NE 183rd St
Aventura, FL 33160
Phone (305) 405-2014

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1742774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742774400000",
    "number": "1720880636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1909 WHEELER RD APT B",
            "city": "NORTH PALM BEACH",
            "state": "FL",
            "postal_code": "334082870",
            "telephone_number": "314-374-9681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1909 WHEELER RD APT B",
            "city": "NORTH PALM BEACH",
            "state": "FL",
            "postal_code": "334082870",
            "telephone_number": "314-374-9681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNISON",
        "first_name": "MICHAEL",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-03-24",
        "last_updated": "2025-03-24",
        "certification_date": "2025-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "FL",
            "license": "22687",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Palm Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.