Individual provider Active NPI

Kathryn Matala Matsubuchi, OT

  • Occupational Therapist
  • Spokane, WA
National Provider Identifier
1093925943
Registry record updated Apr 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OT00002727 Issued in WA
Practice address
3010 S Southeast Blvd Ste G
Spokane, WA 99223-3542
Phone
(509) 532-0500
Fax
(509) 532-8810
NPI assigned
May 22, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2021

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 OT00002727 WA Primary

Addresses

Primary practice location

3010 S Southeast Blvd Ste G
Spokane, WA 99223-3542

Mailing address

3010 S Southeast Blvd Ste G
Spokane, WA 99223-3542
Phone (509) 532-0500

Other identifiers 2

IdentifierTypeStateIssuer
0351054OtherWADEPT OF L&I
1056882MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110903000000 WA Practitioner - Occupational Therapist in Private Practice 7214107077 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Synergy Healthcare Inc.Group PAC ID 7517857899, 6 clinicians

Practice addresses (Care Compare)

12012 E Mission Ave
Spokane Valley, WA 99206-4887
Phone (509) 413-1630

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OT00002727WAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Larry Ham and Associates Physical Therapy PS Occupational Therapist CurrentSince Oct 1, 2020 Accepting new patients
Synergy Healthcare Inc. CurrentSince Dec 27, 2021 Accepting new patients
Spokane Foot Clinic, P S Past Accepting new patients

Locations

3151 E 29th Ave
Spokane, WA 99223
Phone (509) 532-0500

3010 S Southeast Blvd
Ste G
Spokane, WA 99223
Phone (509) 532-0500

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": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619049600000",
    "number": "1093925943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3010 S SOUTHEAST BLVD STE G",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992233542",
            "telephone_number": "509-532-0500",
            "fax_number": "509-532-8810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3010 S SOUTHEAST BLVD STE G",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992233542",
            "telephone_number": "509-532-0500",
            "fax_number": "509-532-8810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATSUBUCHI",
        "first_name": "KATHRYN",
        "middle_name": "MATALA",
        "name_prefix": "Mrs.",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-22",
        "last_updated": "2021-04-22",
        "certification_date": "2021-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WA",
            "license": "OT00002727",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF L&I",
            "identifier": "0351054",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1056882",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.