Active NPI
Elisabeth Landis
- Occupational Therapy Assistant
- Federal Way, WA
National Provider Identifier
1053781641
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- OC60194259
- Practice address
- 1010 S 336TH St
Ste 210
Federal Way, WA 98003-6385 - Phone
- (253) 835-5569
- NPI assigned
- Sep 25, 2015
- 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 |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | OC60194259 | WA | Primary |
Addresses
Primary practice location
1010 S 336TH St
Ste 210
Federal Way, WA 98003-6385
Mailing address
1640 Redstone Center Dr
Suite 200
Park City, UT 84098-7605
Phone (435) 645-0788
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
| License | State | Type | Specialty |
|---|---|---|---|
| OC60194259 | WA | MD | Occupational Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jasima Reynolds | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Home Health Agency
- Park City, UT
- NPI 1699174615
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1443139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1443139200000",
"number": "1053781641",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1640 REDSTONE CENTER DR",
"address_2": "SUITE 200",
"city": "PARK CITY",
"state": "UT",
"postal_code": "840987605",
"telephone_number": "435-645-0788",
"fax_number": "435-645-0792"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1010 S 336TH ST",
"address_2": "STE 210",
"city": "FEDERAL WAY",
"state": "WA",
"postal_code": "980036385",
"telephone_number": "253-835-5569"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LANDIS",
"first_name": "ELISABETH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-09-25",
"last_updated": "2015-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "WA",
"license": "OC60194259",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Federal Way, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.