Active NPI
Susan Waggoner
- Occupational Therapist
- Pittsburgh, PA
National Provider Identifier
1255455895
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OC000785L
- Practice address
- 309 S Lang Ave
Pittsburgh, PA 15208-2749 - Phone
- (412) 719-0703
- NPI assigned
- Mar 19, 2007
- 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 Therapist | 225X00000X | OC000785L | PA | Primary |
Addresses
Primary practice location
309 S Lang Ave
Pittsburgh, PA 15208-2749
Mailing address
309 S Lang Ave
Pittsburgh, PA 15208-2749
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001820914 | Medicaid | PA |
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 |
|---|---|---|---|
| OC000785L | PA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1414972800000",
"number": "1255455895",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "309 S LANG AVE",
"city": "PITTSBURGH",
"state": "PA",
"postal_code": "152082749"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "309 S LANG AVE",
"city": "PITTSBURGH",
"state": "PA",
"postal_code": "152082749",
"telephone_number": "412-719-0703"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGGONER",
"first_name": "SUSAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-19",
"last_updated": "2014-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "PA",
"license": "OC000785L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001820914",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pittsburgh, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 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.