Active NPI
Laurie Connolly, OT
- Physical Medicine & Rehabilitation Physician
- Aberdeen, WA
National Provider Identifier
1104858372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- OT00001109
- Practice address
- 100 S I St
Ste 205
Aberdeen, WA 98520-6502 - Phone
- (360) 532-1707
- Fax
- (360) 532-1703
- NPI assigned
- Jul 7, 2006
- 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 |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | OT00001109 | WA | Primary |
Addresses
Primary practice location
100 S I St
Ste 205
Aberdeen, WA 98520-6502
Mailing address
100 S I St
Ste 205
Aberdeen, WA 98520-6502
Phone (360) 532-1707
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7681679 | Medicaid | WA | |
| GAB34664 | Other | WA | MEDICARE PTAN |
| 0167363 | Other | WA | L & I |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT00001109 | WA | MD | Physical Medicine & Rehabilitation Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aberdeen Therapy Works | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Occupational Therapist
- Aberdeen, WA
- NPI 1437570249
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1466035200000",
"number": "1104858372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 S I ST",
"address_2": "STE 205",
"city": "ABERDEEN",
"state": "WA",
"postal_code": "985206502",
"telephone_number": "360-532-1707",
"fax_number": "360-532-1703"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 S I ST",
"address_2": "STE 205",
"city": "ABERDEEN",
"state": "WA",
"postal_code": "985206502",
"telephone_number": "360-532-1707",
"fax_number": "360-532-1703"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNOLLY",
"first_name": "LAURIE",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-07",
"last_updated": "2016-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "WA",
"license": "OT00001109",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7681679",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "GAB34664",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L & I",
"identifier": "0167363",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Aberdeen, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.