NPIMap

Individual provider Active NPI

Matthew Mallmann, MOTR/L

  • Physical Rehabilitation Occupational Therapist
  • Lake Orion, MI
National Provider Identifier
1811237746
Registry record updated Aug 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Rehabilitation Occupational TherapistTaxonomy code 225XP0019X
License
L2411741 Issued in MI
Practice address
3655 S Baldwin Rd
Lake Orion, MI 48359-1506
Phone
(248) 393-1699
Fax
(248) 393-1711
NPI assigned
Mar 1, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Environmental Modification Occupational Therapist 225XE0001X L2411741 MI
Ergonomics Occupational Therapist 225XE1200X L2411741 MI
Physical Rehabilitation Occupational Therapist 225XP0019X L2411741 MI Primary

Addresses

Primary practice location

3655 S Baldwin Rd
Lake Orion, MI 48359-1506

Mailing address

3655 S Baldwin Rd
Lake Orion, MI 48359-1506
Phone (248) 393-1699

Other identifiers 1

IdentifierTypeStateIssuer
45-4940205OtherMITAX ID

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
L2411741MIMDPhysical Rehabilitation Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Work Rehab Solutions, PLC Environmental Modification 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.

NPI Registry JSON

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

{
    "created_epoch": "1362096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440115200000",
    "number": "1811237746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3655 S BALDWIN RD",
            "city": "LAKE ORION",
            "state": "MI",
            "postal_code": "483591506",
            "telephone_number": "248-393-1699",
            "fax_number": "248-393-1711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3655 S BALDWIN RD",
            "city": "LAKE ORION",
            "state": "MI",
            "postal_code": "483591506",
            "telephone_number": "248-393-1699",
            "fax_number": "248-393-1711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLMANN",
        "first_name": "MATTHEW",
        "name_prefix": "Mr.",
        "credential": "MOTR/L",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-01",
        "last_updated": "2015-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XE0001X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Environmental Modification",
            "state": "MI",
            "license": "L2411741",
            "primary": false
        },
        {
            "code": "225XE1200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Ergonomics",
            "state": "MI",
            "license": "L2411741",
            "primary": false
        },
        {
            "code": "225XP0019X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Physical Rehabilitation",
            "state": "MI",
            "license": "L2411741",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "45-4940205",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Orion, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2015; 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.