Individual provider Active NPI

Amanda Klotter, OT

  • Occupational Therapist
  • Beavercreek, OH
National Provider Identifier
1053943142
Registry record updated Jul 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OT010878 Issued in OH
Practice address
3817 Colonel Glenn Hwy
Beavercreek, OH 45324-2268
Phone
(937) 427-9200
NPI assigned
Feb 7, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X OT010878 OH Primary

Addresses

Primary practice location

3817 Colonel Glenn Hwy
Beavercreek, OH 45324-2268

Mailing address

7591 Tylers Place Blvd
West Chester, OH 45069-6308
Phone (513) 755-6600

Other identifiers 1

IdentifierTypeStateIssuer
0406425MedicaidOH

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
OT010878OHMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Abc Pediatric Therapy LLC Occupational Therapist PastSince Feb 9, 2020 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.

NPI Registry JSON

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

{
    "created_epoch": "1581033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595462400000",
    "number": "1053943142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7591 TYLERS PLACE BLVD",
            "city": "WEST CHESTER",
            "state": "OH",
            "postal_code": "450696308",
            "telephone_number": "513-755-6600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3817 COLONEL GLENN HWY",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "453242268",
            "telephone_number": "937-427-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLOTTER",
        "first_name": "AMANDA",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-07",
        "last_updated": "2020-07-23",
        "certification_date": "2020-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "OH",
            "license": "OT010878",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0406425",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beavercreek, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2020; 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.