Active NPI
Merrill St Aubin, OT
- Occupational Therapist
- St Oglethorpe, GA
National Provider Identifier
1962570697
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT004001
- Practice address
- 118 Herron Street
St Oglethorpe, GA 30742 - Phone
- (706) 861-7471
- Fax
- (706) 861-7472
- NPI assigned
- Dec 1, 2006
- 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 | OT004001 | GA | Primary |
Addresses
Primary practice location
118 Herron Street
St Oglethorpe, GA 30742
Mailing address
118 Herron Street
St Oglethorpe, GA 30742
Phone (706) 861-7471
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 52153869002 | Other | GA | BCBS |
| 4094229 | Other | TN | BCBS |
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 |
|---|---|---|---|
| OT004001 | GA | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Georgia Pediatric Therapies, LLC | Occupational Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Fort Oglethorpe, GA
- NPI 1447499132
Occupational Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1962570697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "118 HERRON STREET",
"city": "ST OGLETHORPE",
"state": "GA",
"postal_code": "30742",
"telephone_number": "706-861-7471",
"fax_number": "706-861-7472"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "118 HERRON STREET",
"city": "ST OGLETHORPE",
"state": "GA",
"postal_code": "30742",
"telephone_number": "706-861-7471",
"fax_number": "706-861-7472"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ST AUBIN",
"first_name": "MERRILL",
"name_prefix": "Mrs.",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "GA",
"license": "OT004001",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "52153869002",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "4094229",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in St Oglethorpe, GA
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.