Active NPI
Jonah Lytch, COTA
- Occupational Therapy Assistant
- Advance, NC
National Provider Identifier
1083174635
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 5189
- Practice address
- 142 Bermuda Village Dr
Advance, NC 27006-7867 - Phone
- (336) 998-6763
- NPI assigned
- Mar 20, 2019
- 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 | 5189 | NC | Primary |
Addresses
Primary practice location
142 Bermuda Village Dr
Advance, NC 27006-7867
Mailing address
935 Boyer Dr
Clemmons, NC 27012-9476
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 |
|---|---|---|---|
| 5189 | NC | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1553040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1553040000000",
"number": "1083174635",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "935 BOYER DR",
"city": "CLEMMONS",
"state": "NC",
"postal_code": "270129476"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "142 BERMUDA VILLAGE DR",
"city": "ADVANCE",
"state": "NC",
"postal_code": "270067867",
"telephone_number": "336-998-6763"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LYTCH",
"first_name": "JONAH",
"credential": "COTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-03-20",
"last_updated": "2019-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "NC",
"license": "5189",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Advance, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.