Melissa Anne Cogburn

Key facts

NPI

1013670686

Entity type

Individual (NPI type 1)

Primary specialty

Occupational Therapist 225X00000X

License

OT61193885 (WA)

Practice address

121 Whitesell St NE
Orting, WA 98360-8410

Phone

(360) 893-6500

NPI assigned

Oct 20, 2021

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 20, 2021.

{
    "created_epoch": "1634688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634688000000",
    "number": "1013670686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11622 208TH AVENUE CT E",
            "city": "SUMNER",
            "state": "WA",
            "postal_code": "983917765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 WHITESELL ST NE",
            "city": "ORTING",
            "state": "WA",
            "postal_code": "983608410",
            "telephone_number": "360-893-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COGBURN",
        "first_name": "MELISSA",
        "middle_name": "ANNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-20",
        "last_updated": "2021-10-20",
        "certification_date": "2021-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WA",
            "license": "OT61193885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Orting, WA · Occupational Therapist in Washington