Active NPI
Rena Ann Moore, OTRL
- Occupational Therapist
- Muskegon, MI
National Provider Identifier
1780257014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 5201009053
- Practice address
- 695 Mitzi St
Muskegon, MI 49445-3232 - Phone
- (231) 744-1641
- NPI assigned
- Jul 23, 2021
- 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 | 5201009053 | MI | Primary |
Addresses
Primary practice location
695 Mitzi St
Muskegon, MI 49445-3232
Mailing address
2600 Compass Rd
Glenview, IL 60026-8001
Phone (877) 787-3430
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 17992 | Medicaid | IL |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | healthcareinformationexchange | Health Information Exchange (HIE) |
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 |
|---|---|---|---|
| 5201009053 | MI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626998400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626998400000",
"number": "1780257014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2600 COMPASS RD",
"city": "GLENVIEW",
"state": "IL",
"postal_code": "600268001",
"telephone_number": "877-787-3430"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "695 MITZI ST",
"city": "MUSKEGON",
"state": "MI",
"postal_code": "494453232",
"telephone_number": "231-744-1641"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "RENA",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"credential": "OTRL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-07-23",
"last_updated": "2021-07-23",
"certification_date": "2021-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MI",
"license": "5201009053",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "17992",
"state": "IL"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "healthcareinformationexchange",
"affiliation": "N",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "695 Mitzi St",
"city": "Muskegon",
"state": "MI",
"country_code": "US",
"postal_code": "494453232",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Muskegon, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.