Individual provider Active NPI

Stephanie G Ota, MSPT

  • Physical Medicine & Rehabilitation Physician
  • Spokane, WA
National Provider Identifier
1104965508
Registry record updated Apr 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
8396 Issued in WA
Practice address
2507 E 27TH Ave
Spokane, WA 99223-4908
Phone
(509) 456-6917
Fax
(509) 456-5902
NPI assigned
Feb 5, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 8396 WA Primary

Addresses

Primary practice location

2507 E 27TH Ave
Spokane, WA 99223-4908

Mailing address

3020 S Grand Blvd
Spokane, WA 99203
Phone (509) 456-6917

Other identifiers 1

IdentifierTypeStateIssuer
8349995MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101106000062 WA Practitioner - Physical Therapist in Private Practice 0840485694 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physical Therapy Associates PSGroup PAC ID 7810885662, 12 clinicians

Practice addresses (Care Compare)

2507 E 27TH Ave
Spokane, WA 99223-4908
Phone (509) 456-6917

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8396WAMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Physical Therapy Associates PS Physical Medicine & Rehabilitation CurrentSince Feb 3, 2003 Accepting new patients
Physical Therapy Associates Past Accepting new patients

Locations

2507 E 27th Ave
Spokane, WA 99223
Phone (509) 456-6917

3020 S Grand Blvd
Spokane, WA 99203
Phone (509) 436-6917

Organizations & group practices 2

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": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524614400000",
    "number": "1104965508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 S GRAND BLVD",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "99203",
            "telephone_number": "509-456-6917",
            "fax_number": "509-456-5902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2507 E 27TH AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992234908",
            "telephone_number": "509-456-6917",
            "fax_number": "509-456-5902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTA",
        "first_name": "STEPHANIE",
        "middle_name": "G",
        "name_prefix": "Mrs.",
        "credential": "MSPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-05",
        "last_updated": "2018-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "WA",
            "license": "8396",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8349995",
            "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 25, 2018; 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.