Active NPI
Ellen Grace-Gombar Krause, OTR/L
- Occupational Therapist
- Kingsley, MI
National Provider Identifier
1790229953
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 5201009038
- Practice address
- 4040 Beacon St
Kingsley, MI 49649-9548 - Phone
- (231) 263-1350
- NPI assigned
- Dec 7, 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 | 5201009038 | MI | Primary |
Addresses
Primary practice location
4040 Beacon St
Kingsley, MI 49649-9548
Mailing address
4040 Beacon St
Kingsley, MI 49649-9548
Phone (231) 263-1350
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 |
|---|---|---|---|
| 5201009038 | MI | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lighthouse, Inc. | Past | 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.
-
- Rehabilitation Clinic/Center
- Caro, MI
- NPI 1770661092
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1481068800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1617667200000",
"number": "1790229953",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4040 BEACON ST",
"city": "KINGSLEY",
"state": "MI",
"postal_code": "496499548",
"telephone_number": "231-263-1350"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4040 BEACON ST",
"city": "KINGSLEY",
"state": "MI",
"postal_code": "496499548",
"telephone_number": "231-263-1350"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRAUSE",
"first_name": "ELLEN",
"middle_name": "GRACE-GOMBAR",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-12-07",
"last_updated": "2021-04-06",
"certification_date": "2021-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MI",
"license": "5201009038",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kingsley, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 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.