Active NPI
Breanna Kaitlyn Carlson
- Occupational Therapist
- Bolingbrook, IL
National Provider Identifier
1851734172
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- Practice address
- 168 Beaconridge Dr
Bolingbrook, IL 60440-2936 - Phone
- (815) 260-2977
- NPI assigned
- Apr 17, 2013
- Sex
- Female
- Sole proprietor
- Yes
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 | Primary |
Addresses
Primary practice location
168 Beaconridge Dr
Bolingbrook, IL 60440-2936
Mailing address
168 Beaconridge
Bolingbrook, IL 60440
Phone (815) 260-2977
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1366156800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366156800000",
"number": "1851734172",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "168 BEACONRIDGE",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "60440",
"telephone_number": "815-260-2977"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "168 BEACONRIDGE DR",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604402936",
"telephone_number": "815-260-2977"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLSON",
"first_name": "BREANNA",
"middle_name": "KAITLYN",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-04-17",
"last_updated": "2013-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bolingbrook, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 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.