Active NPI
Patricia Ann Wallace, O.T.
- Occupational Therapist
- Indianapolis, IN
National Provider Identifier
1851354492
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 31000396A
- Practice address
- 5949 W Raymond St
Indianapolis, IN 46241-4348 - Phone
- (317) 247-1579
- NPI assigned
- Apr 6, 2006
- 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 | 31000396A | IN | Primary |
Addresses
Primary practice location
5949 W Raymond St
Indianapolis, IN 46241-4348
Mailing address
790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2223
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000355350 | Other | IN | ANTHEM ID |
| 200515660 | Medicaid | IN |
Other names 1
- Patricia Ann Glomski
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144281600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375660800000",
"number": "1851354492",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "790 REMINGTON BLVD",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604404909",
"telephone_number": "630-296-2223"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5949 W RAYMOND ST",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462414348",
"telephone_number": "317-247-1579"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "PATRICIA",
"middle_name": "ANN",
"credential": "O.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-06",
"last_updated": "2013-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IN",
"license": "31000396A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM ID",
"identifier": "000000355350",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200515660",
"state": "IN"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "PATRICIA",
"last_name": "GLOMSKI",
"middle_name": "ANN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.