Active NPI
Lorraine M Street, OTR/L
- Occupational Therapist
- Jackson, MS
National Provider Identifier
1770716615
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT0074
- 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
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 | 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05423701 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| OT0074 | MS | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Safe at Home LLC | Occupational Therapist | Current | 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.