Individual provider Active NPI

Carly Emond

  • Occupational Therapist
  • Bellingham, WA
National Provider Identifier
1053965830
Registry record updated Jul 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
60956208 Issued in WA
Practice address
4680 Cordata Pkwy
Bellingham, WA 98226-8038
Phone
(360) 398-1966
NPI assigned
Jul 30, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 30, 2019

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 60956208 WA Primary

Addresses

Primary practice location

4680 Cordata Pkwy
Bellingham, WA 98226-8038

Mailing address

2414 F St
Bellingham, WA 98225-3711
Phone (802) 451-6331

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221002000037 ME Practitioner - Occupational Therapist in Private Practice 3870979669 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
60956208WAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Central Maine Medical Center CurrentSince Jul 27, 2022 Accepting new patients
Central Maine Medical Center CurrentSince Jul 27, 2022 Accepting new patients
Central Maine Medical Center Current Accepting new patients

Locations

300 Main St
Lewiston, ME 04240
Phone (207) 795-2400

77 Bates St
Ste 202
Lewiston, ME 04240
Phone (207) 784-5784

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/4517c430-03bf-4e32-b324-1387cc4e73f3/

Organizations & group practices 3

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": "1564444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564444800000",
    "number": "1053965830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2414 F ST",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982253711",
            "telephone_number": "802-451-6331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4680 CORDATA PKWY",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982268038",
            "telephone_number": "360-398-1966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EMOND",
        "first_name": "CARLY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-30",
        "last_updated": "2019-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WA",
            "license": "60956208",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellingham, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.