Individual provider Active NPI

Marina Soledad Amen - Walker, COTA

  • Occupational Therapy Assistant
  • Omaha, NE
National Provider Identifier
1235642638
Registry record updated Sep 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
15868 Issued in FL
Practice address
13609 California St
Omaha, NE 68154-5260
Phone
(800) 456-5857
Fax
(402) 895-7812
NPI assigned
Nov 8, 2017
Last updated
Sep 5, 2019By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 5, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 0131-002105 VA
Occupational Therapy Assistant 224Z00000X 0000990 CO
Occupational Therapy Assistant 224Z00000X 15868 FL Primary

Addresses

Primary practice location

13609 California St
Omaha, NE 68154-5260

Mailing address

1415 Eddy St
Merritt Island, FL 32952-5730
Phone (321) 243-2189

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

LicenseStateTypeSpecialty
15868FLMDOccupational Therapy Assistant
0131-002105VAMDOccupational Therapy Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1510099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567641600000",
    "number": "1235642638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 EDDY ST",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329525730",
            "telephone_number": "321-243-2189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13609 CALIFORNIA ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681545260",
            "telephone_number": "800-456-5857",
            "fax_number": "402-895-7812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMEN - WALKER",
        "first_name": "MARINA",
        "middle_name": "SOLEDAD",
        "name_prefix": "Mrs.",
        "credential": "COTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-11-08",
        "last_updated": "2019-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "VA",
            "license": "0131-002105",
            "primary": false
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "CO",
            "license": "0000990",
            "primary": false
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "FL",
            "license": "15868",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.