Active NPI
Amy Vandaveer, COTA
- Occupational Therapy Assistant
- Cole Camp, MO
National Provider Identifier
1194121251
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 2014003564
- Practice address
- 403 W Main St
Cole Camp, MO 65325-1144 - Phone
- (660) 668-4515
- NPI assigned
- Nov 17, 2014
- Last updated
- Nov 17, 2014
- 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 | 2014003564 | MO | Primary |
Addresses
Primary practice location
403 W Main St
Cole Camp, MO 65325-1144
Mailing address
3105 Bluff Creek Dr
Columbia, MO 65201-3529
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 |
|---|---|---|---|
| 2014003564 | MO | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1416182400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1416182400000",
"number": "1194121251",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3105 BLUFF CREEK DR",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652013529"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "403 W MAIN ST",
"city": "COLE CAMP",
"state": "MO",
"postal_code": "653251144",
"telephone_number": "660-668-4515"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDAVEER",
"first_name": "AMY",
"credential": "COTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-11-17",
"last_updated": "2014-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "MO",
"license": "2014003564",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cole Camp, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.