Active NPI
Kelly Rene Bousson, MS,OTR
- Occupational Therapist
- Muskegon, MI
National Provider Identifier
1902002298
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 5201006679
- Practice address
- 1080 E Sternberg Rd
Muskegon
Muskegon, MI 49444-8796 - Phone
- (231) 799-2200
- NPI assigned
- Jun 22, 2007
- 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 | 5201006679 | MI | Primary |
Addresses
Primary practice location
1080 E Sternberg Rd
Muskegon
Muskegon, MI 49444-8796
Mailing address
809 E Filer St
Ludington
Ludington, MI 49431-2210
Phone (231) 233-3272
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5201006679 | MI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182470400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1902002298",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "809 E FILER ST",
"address_2": "LUDINGTON",
"city": "LUDINGTON",
"state": "MI",
"postal_code": "494312210",
"telephone_number": "231-233-3272"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1080 E STERNBERG RD",
"address_2": "MUSKEGON",
"city": "MUSKEGON",
"state": "MI",
"postal_code": "494448796",
"telephone_number": "231-799-2200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUSSON",
"first_name": "KELLY",
"middle_name": "RENE",
"credential": "MS,OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MI",
"license": "5201006679",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Muskegon, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.