Active NPI
Tracey L Airth-Edblom, OTR/L, CHT
- Hand Occupational Therapist
- Petaluma, CA
National Provider Identifier
1053571307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hand Occupational Therapist
- License
- OT345
- Practice address
- 226 Weller St
Petaluma, CA 94952-3136 - Phone
- (707) 762-7678
- Fax
- (707) 762-7679
- NPI assigned
- Jun 11, 2008
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Hand Occupational Therapist | 225XH1200X | OT345 | CA | Primary |
Addresses
Primary practice location
226 Weller St
Petaluma, CA 94952-3136
Mailing address
8 Pacific Dr
Novato, CA 94949-5479
Phone (415) 382-8202
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 345 | CA | MD | Dental Hygienist |
| OT345 | CA | MD | Hand Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213142400000",
"number": "1053571307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8 PACIFIC DR",
"city": "NOVATO",
"state": "CA",
"postal_code": "949495479",
"telephone_number": "415-382-8202",
"fax_number": "415-382-8212"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "226 WELLER ST",
"city": "PETALUMA",
"state": "CA",
"postal_code": "949523136",
"telephone_number": "707-762-7678",
"fax_number": "707-762-7679"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AIRTH-EDBLOM",
"first_name": "TRACEY",
"middle_name": "L",
"credential": "OTR/L, CHT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-06-11",
"last_updated": "2008-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "225XH1200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Hand",
"state": "CA",
"license": "OT345",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Petaluma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.