Michael Tavares

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

46TR00675100 Issued in NJ

Practice address

128 Hawthorne CT
Rockaway, NJ 07866-2252

Phone

(973) 907-3624

NPI assigned

Sep 18, 2018

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1537228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537228800000",
    "number": "1891279600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 HAWTHORNE CT",
            "city": "ROCKAWAY",
            "state": "NJ",
            "postal_code": "078662252",
            "telephone_number": "973-907-3624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 HAWTHORNE CT",
            "city": "ROCKAWAY",
            "state": "NJ",
            "postal_code": "078662252",
            "telephone_number": "973-907-3624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAVARES",
        "first_name": "MICHAEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-09-18",
        "last_updated": "2018-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist",
            "state": "NJ",
            "license": "46TR00675100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in Rockaway, NJ
• Providers in Rockaway, NJ by specialty
• Occupational Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2018; 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.