Active NPI
Melissa Marie Forncrook, OT
- Occupational Therapist
- Stockton, CA
National Provider Identifier
1790769198
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT 4216
- Practice address
- 5910 Pacific Ave
Stockton, CA 95207-4704 - Phone
- (209) 475-1000
- Fax
- (209) 475-1809
- NPI assigned
- Nov 30, 2005
- 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 | OT 4216 | CA | Primary |
Addresses
Primary practice location
5910 Pacific Ave
Stockton, CA 95207-4704
Mailing address
2000 Garden Rd
Monterey, CA 93940-5313
Phone (831) 375-1885
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT 4216 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133308800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1465948800000",
"number": "1790769198",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2000 GARDEN RD",
"city": "MONTEREY",
"state": "CA",
"postal_code": "939405313",
"telephone_number": "831-375-1885",
"fax_number": "831-375-7436"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5910 PACIFIC AVE",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952074704",
"telephone_number": "209-475-1000",
"fax_number": "209-475-1809"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORNCROOK",
"first_name": "MELISSA",
"middle_name": "MARIE",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-30",
"last_updated": "2016-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "OT 4216",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.