NPIMap

Individual provider Active NPI

Amanda Elizabeth Nicolussi, MOT, OTR/L

  • Pediatric Occupational Therapist
  • Plymouth, MI
National Provider Identifier
1982935540
Registry record updated May 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
License
056.008910 Issued in IL
Practice address
9357 General Dr
Plymouth, MI 48170-4662
Phone
(734) 454-0866
NPI assigned
Jan 21, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Occupational Therapist 225XP0200X 056.008910 IL Primary
Occupational Therapist 225X00000X 5201008235 MI

Addresses

Primary practice location

9357 General Dr
Plymouth, MI 48170-4662

Mailing address

9357 General Dr
Plymouth, MI 48170-4662
Phone (734) 454-0866

Other names 1

  • Amanda Elizabeth Haseltine Former name

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

LicenseStateTypeSpecialty
5201008235MIMDOccupational Therapist
056.008910ILMDPediatric Occupational Therapist

NPI Registry JSON

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

{
    "created_epoch": "1264032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368748800000",
    "number": "1982935540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9357 GENERAL DR",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481704662",
            "telephone_number": "734-454-0866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9357 GENERAL DR",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481704662",
            "telephone_number": "734-454-0866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICOLUSSI",
        "first_name": "AMANDA",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "MOT, OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-01-21",
        "last_updated": "2013-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "IL",
            "license": "056.008910",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MI",
            "license": "5201008235",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "HASELTINE",
            "middle_name": "ELIZABETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Plymouth, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2013; 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.