Individual provider Active NPI

Susanne Cecil, COTA/L

  • Occupational Therapy Assistant
  • Jefferson City, MO
National Provider Identifier
1790937381
Registry record updated Jun 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
2009010789 Issued in MO
Practice address
208 Michelle Dr
Jefferson City, MO 65109-0136
Phone
(330) 206-5299
NPI assigned
Oct 15, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 30, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 2009010789 MO Primary

Addresses

Primary practice location

208 Michelle Dr
Jefferson City, MO 65109-0136

Mailing address

208 Michelle Dr
Jefferson City, MO 65109-0136
Phone (330) 206-5299

Other names 1

  • Susanne Goldsmith Former name

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

LicenseStateTypeSpecialty
2009010789MOMDOccupational Therapy Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1224028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309392000000",
    "number": "1790937381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 MICHELLE DR",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651090136",
            "telephone_number": "330-206-5299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 MICHELLE DR",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651090136",
            "telephone_number": "330-206-5299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CECIL",
        "first_name": "SUSANNE",
        "name_prefix": "Mrs.",
        "credential": "COTA/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-10-15",
        "last_updated": "2011-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "MO",
            "license": "2009010789",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSANNE",
            "last_name": "GOLDSMITH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Jefferson City, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.