Active NPI
Jordynne Carmichael-Green
- Occupational Therapist
- Canon City, CO
National Provider Identifier
1972104297
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT.0006537
- Practice address
- 515 Fairview Ave
Canon City, CO 81212-2863 - Phone
- (719) 275-0655
- NPI assigned
- Nov 3, 2020
- 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 Therapist | 225X00000X | OT.0006537 | CO | Primary |
Addresses
Primary practice location
515 Fairview Ave
Canon City, CO 81212-2863
Mailing address
313 Bellows CT
Canon City, CO 81212-9515
Phone (570) 447-9263
Other practice location 1
1401 Phay Ave
Canon City, CO 81212-2303
Phone (719) 275-8656
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 |
|---|---|---|---|
| OT.0006537 | CO | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713830400000",
"number": "1972104297",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "313 BELLOWS CT",
"city": "CANON CITY",
"state": "CO",
"postal_code": "812129515",
"telephone_number": "570-447-9263"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "515 FAIRVIEW AVE",
"city": "CANON CITY",
"state": "CO",
"postal_code": "812122863",
"telephone_number": "719-275-0655"
}
],
"practiceLocations": [
{
"address_1": "1401 Phay Ave",
"address_purpose": "LOCATION",
"city": "Canon City",
"state": "CO",
"postal_code": "812122303",
"country_code": "US",
"telephone_number": "719-275-8656",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CARMICHAEL-GREEN",
"first_name": "JORDYNNE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-11-03",
"last_updated": "2024-04-23",
"certification_date": "2024-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CO",
"license": "OT.0006537",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canon City, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.