Active NPI
Mikaela Paige Blum, OTR/L
- Occupational Therapist
- Ault, CO
National Provider Identifier
1962169656
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OTP-OT-LIC-8583
- Practice address
- 617 Santa Fe Trail
Ault, CO 80610 - Phone
- (970) 324-0899
- NPI assigned
- Nov 17, 2021
- 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 | OTP-OT-LIC-8583 | MT | Primary |
Addresses
Primary practice location
617 Santa Fe Trail
Ault, CO 80610
Mailing address
617 Santa Fe Trail
Ault, CO 80610
Phone (970) 324-0899
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OTP-OT-LIC-8583 | MT | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1637107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679529600000",
"number": "1962169656",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "617 SANTA FE TRAIL",
"city": "AULT",
"state": "CO",
"postal_code": "80610",
"telephone_number": "970-324-0899"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "617 SANTA FE TRAIL",
"city": "AULT",
"state": "CO",
"postal_code": "80610",
"telephone_number": "970-324-0899"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLUM",
"first_name": "MIKAELA",
"middle_name": "PAIGE",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-11-17",
"last_updated": "2023-03-23",
"certification_date": "2023-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MT",
"license": "OTP-OT-LIC-8583",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ault, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.