Active NPI
Jennifer Fortuna, OTR/L
- Occupational Therapist
- Grand Rapids, MI
National Provider Identifier
1912400383
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 5201008980
- Practice address
- 625 Kenmoor Ave SE Ste 306
Grand Rapids, MI 49546-2395 - Phone
- (616) 942-5744
- NPI assigned
- Mar 13, 2018
- 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 | 5201008980 | MI | Primary |
Addresses
Primary practice location
625 Kenmoor Ave SE Ste 306
Grand Rapids, MI 49546-2395
Mailing address
1859 Valley Pines Dr
Hastings, MI 49058-8261
Phone (616) 724-0338
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306876438 | Medicaid | MI |
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": "1520899200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1520899200000",
"number": "1912400383",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1859 VALLEY PINES DR",
"city": "HASTINGS",
"state": "MI",
"postal_code": "490588261",
"telephone_number": "616-724-0338"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "625 KENMOOR AVE SE STE 306",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495462395",
"telephone_number": "616-942-5744"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORTUNA",
"first_name": "JENNIFER",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-03-13",
"last_updated": "2018-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MI",
"license": "5201008980",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1306876438",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 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.