Jackie McCullough, MOTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

Practice address

19135 Holdren St
Brownstown, MI 48173-9307

Phone

(313) 999-0873

NPI assigned

May 28, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Tmi East, Inc.

  • Rehabilitation Clinic/Center
  • Saginaw, MI
  • NPI 1336709252
  Medicare reassignment NPD

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

{
    "created_epoch": "1527465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527465600000",
    "number": "1841781606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28349 JOY RD",
            "city": "WESTLAND",
            "state": "MI",
            "postal_code": "481855524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19135 HOLDREN ST",
            "city": "BROWNSTOWN",
            "state": "MI",
            "postal_code": "481739307",
            "telephone_number": "313-999-0873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "JACKIE",
        "credential": "MOTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-05-28",
        "last_updated": "2018-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Ian Maki, D.P.M.
• Bernard Mendoza Marquillero, RN
• Mary Rose Corporation
• Matrix Home Health Care LLC
• Matrix Home Health Services LLC
• Barbara Joyce McKenzie-Westley, R.N.
• Margaret A McQuiston
• Andrew Medalla, PT
• Kristan Mika, PHARMD
• Tiffany Miller, FNP-C

• Occupational Therapist in Brownstown, MI
• Providers in Brownstown, MI by specialty
• Occupational Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.