Individual provider Active NPI

Sara Wyckoff, OTR

  • Pediatric Occupational Therapist
  • Shoreline, WA
National Provider Identifier
1033244389
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
License
OT00000491 Issued in WA
Practice address
20310 19TH Ave NE
Shoreline, WA 98155-1261
Phone
(206) 367-5853
NPI assigned
Feb 23, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Occupational Therapist 225XP0200X OT00000491 WA Primary

Addresses

Primary practice location

20310 19TH Ave NE
Shoreline, WA 98155-1261

Mailing address

19916 19TH Ave NE Apt 301
Shoreline, WA 98155-8205
Phone (206) 363-4008

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
OT00000491WAMDPediatric Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Child & Family Mental Health Services LLC PastSince Jun 22, 2021 Accepting new patients
PT & OT of Washington, LLC Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1033244389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19916 19TH AVE NE APT 301",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "981558205",
            "telephone_number": "206-363-4008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20310 19TH AVE NE",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "981551261",
            "telephone_number": "206-367-5853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYCKOFF",
        "first_name": "SARA",
        "credential": "OTR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "WA",
            "license": "OT00000491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shoreline, WA

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.

Verify at the official NPI Registry.