Individual provider Active NPI

Lorraine M Street, OTR/L

  • Occupational Therapist
  • Jackson, MS
National Provider Identifier
1770716615
Registry record updated Aug 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OT0074 Issued in MS
Practice address
4500 I 55 N
Suite 291, Highland Village
Jackson, MS 39211-5930
Phone
(601) 362-0859
Fax
(601) 362-0870
NPI assigned
Aug 26, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2009

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 OT0074 MS Primary

Addresses

Primary practice location

4500 I 55 N
Suite 291, Highland Village
Jackson, MS 39211-5930

Mailing address

4500 I 55 N
Suite 291, Highland Village
Jackson, MS 39211-5930
Phone (601) 362-0859

Other identifiers 1

IdentifierTypeStateIssuer
05423701MedicaidMS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250309000047 MS Practitioner - Occupational Therapist in Private Practice 4183145014 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OT0074MSMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Safe at Home LLC Occupational Therapist CurrentSince Feb 5, 2025 Accepting new patients

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": "1251244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1251244800000",
    "number": "1770716615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 I 55 N",
            "address_2": "SUITE 291, HIGHLAND VILLAGE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392115930",
            "telephone_number": "601-362-0859",
            "fax_number": "601-362-0870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 I 55 N",
            "address_2": "SUITE 291, HIGHLAND VILLAGE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392115930",
            "telephone_number": "601-362-0859",
            "fax_number": "601-362-0870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STREET",
        "first_name": "LORRAINE",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-26",
        "last_updated": "2009-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MS",
            "license": "OT0074",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05423701",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.