Susan Mockalis, M.S., OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT006051 Issued in GA

Practice address

304 Emory St
Valdosta, GA 31602-1808

Phone

(229) 244-1667

Fax

(229) 244-8253

NPI assigned

Jul 25, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

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.

• Choice Family Medicine, PC

  • Primary Care Clinic/Center
  • Valdosta, GA
  • NPI 1609087469
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1469404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469404800000",
    "number": "1982157012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2406 DAVIS AVE",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 EMORY ST",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021808",
            "telephone_number": "229-244-1667",
            "fax_number": "229-244-8253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOCKALIS",
        "first_name": "SUSAN",
        "credential": "M.S., OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-25",
        "last_updated": "2016-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "GA",
            "license": "OT006051",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEORGIA STATE LICENSE",
            "identifier": "OT006051",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in Valdosta, GA
• Providers in Valdosta, GA by specialty
• Occupational Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.