Active NPI
Octavia Deshaun Richardson, LPTA
- Physical Therapy Assistant
- North Randall, OH
National Provider Identifier
1093831729
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 06426
- Practice address
- 20265 Emery Rd
North Randall, OH 44128-4122 - Phone
- (216) 584-2720
- NPI assigned
- Mar 22, 2007
- 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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 06426 | OH | Primary |
Addresses
Primary practice location
20265 Emery Rd
North Randall, OH 44128-4122
Mailing address
13204 Griffing Ave Apt 7
Cleveland, OH 44120-3080
Phone (216) 921-0981
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 |
|---|---|---|---|
| 06426 | OH | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1093831729",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13204 GRIFFING AVE APT 7",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441203080",
"telephone_number": "216-921-0981"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20265 EMERY RD",
"city": "NORTH RANDALL",
"state": "OH",
"postal_code": "441284122",
"telephone_number": "216-584-2720"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RICHARDSON",
"first_name": "OCTAVIA",
"middle_name": "DESHAUN",
"name_prefix": "Ms.",
"credential": "LPTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "OH",
"license": "06426",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Randall, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.