Active NPI
Mariah Nicole Shane
- Occupational Therapy Assistant
- Orlando, FL
National Provider Identifier
1932850765
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 18624
- Practice address
- 13574 Village Park Dr
Orlando, FL 32837-7689 - Phone
- (407) 990-2847
- NPI assigned
- Jan 13, 2022
- 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 Therapy Assistant | 224Z00000X | 18624 | FL | Primary |
Addresses
Primary practice location
13574 Village Park Dr
Orlando, FL 32837-7689
Mailing address
13574 Village Park Dr
Orlando, FL 32837-7689
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | OccupationalTherapist |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 18624 | FL | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1642032000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642032000000",
"number": "1932850765",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13574 VILLAGE PARK DR",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328377689"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13574 VILLAGE PARK DR",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328377689",
"telephone_number": "407-990-2847"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANE",
"first_name": "MARIAH",
"middle_name": "NICOLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-01-13",
"last_updated": "2022-01-13",
"certification_date": "2022-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "FL",
"license": "18624",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "SOAP",
"endpointTypeDescription": "SOAP URL",
"endpoint": "OccupationalTherapist",
"affiliation": "N",
"address_1": "13574 Village Park Dr",
"city": "Orlando",
"state": "FL",
"country_code": "US",
"postal_code": "328377689",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Orlando, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.