Active NPI
Yaisha Dameka Bush, COTA
- Occupational Therapy Assistant
- Healdsburg, CA
National Provider Identifier
1063183135
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 5025
- Practice address
- 725 Grove St
Healdsburg, CA 95448-4756 - Phone
- (707) 433-4877
- NPI assigned
- Sep 28, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 | 5025 | CA | Primary |
Addresses
Primary practice location
725 Grove St
Healdsburg, CA 95448-4756
Mailing address
3409 Lake Park CT
Santa Rosa, CA 95403-5726
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 |
|---|---|---|---|
| 5025 | CA | MD | Anatomic Pathology & Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632787200000",
"number": "1063183135",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3409 LAKE PARK CT",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954035726"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "725 GROVE ST",
"city": "HEALDSBURG",
"state": "CA",
"postal_code": "954484756",
"telephone_number": "707-433-4877"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUSH",
"first_name": "YAISHA",
"middle_name": "DAMEKA",
"credential": "COTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-09-28",
"last_updated": "2021-09-28",
"certification_date": "2021-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "CA",
"license": "5025",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Healdsburg, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.