Individual provider Active NPI

Jannifer A Kincaid, OTR/L

  • Occupational Therapist
  • Burton, MI
National Provider Identifier
1912283243
Registry record updated Nov 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
5201008075 Issued in MI
Practice address
1516 E Buder Ave
Burton, MI 48529-1606
Phone
(810) 919-5355
NPI assigned
Nov 1, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 5201008075 MI Primary

Addresses

Primary practice location

1516 E Buder Ave
Burton, MI 48529-1606

Mailing address

1516 E Buder Ave
Burton, MI 48529-1606
Phone (810) 919-5355

Other identifiers 1

IdentifierTypeStateIssuer
5201008075OtherMIPROFESSIONAL LICENSE NUMBER

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

State licenses

LicenseStateTypeSpecialty
5201008075MIMDOccupational Therapist

NPI Registry JSON

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

{
    "created_epoch": "1320105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320105600000",
    "number": "1912283243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1516 E BUDER AVE",
            "city": "BURTON",
            "state": "MI",
            "postal_code": "485291606",
            "telephone_number": "810-919-5355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1516 E BUDER AVE",
            "city": "BURTON",
            "state": "MI",
            "postal_code": "485291606",
            "telephone_number": "810-919-5355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINCAID",
        "first_name": "JANNIFER",
        "middle_name": "A",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-01",
        "last_updated": "2011-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MI",
            "license": "5201008075",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROFESSIONAL LICENSE NUMBER",
            "identifier": "5201008075",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burton, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2011; 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.