Individual provider Active NPI

Charlotte Ela Watership, OTR/L

  • Occupational Therapist
  • Bend, OR
National Provider Identifier
1285903534
Registry record updated Dec 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
389452 Issued in OR
Practice address
404 NE Penn Ave
Bend, OR 97701-4264
Phone
(541) 318-7041
Fax
(541) 388-3711
NPI assigned
Dec 15, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 389452 OR Primary

Addresses

Primary practice location

404 NE Penn Ave
Bend, OR 97701-4264

Mailing address

404 NE Penn Ave
Bend, OR 97701-4264
Phone (541) 318-7041

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190625000369 WA Practitioner - Other (Non-Physician) 6002884715 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Undefined Non-Physician Type (Specify)
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1025 S 2ND Ave
Walla Walla, WA 99362-4116
Phone (509) 897-3000

380 Chase Ave
Walla Walla, WA 99362-2924
Phone (509) 897-3333

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
389452ORMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Washington CurrentSince Jun 1, 2019 Accepting new patients
Providence Health & Services - Washington Past Accepting new patients

Locations

380 Chase Ave
Walla Walla, WA 99362
Phone (509) 526-3333

1025 S 2nd Ave
Walla Walla, WA 99362
Phone (509) 525-0480

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": "1323907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323907200000",
    "number": "1285903534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 NE PENN AVE",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977014264",
            "telephone_number": "541-318-7041",
            "fax_number": "541-388-3711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 NE PENN AVE",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977014264",
            "telephone_number": "541-318-7041",
            "fax_number": "541-388-3711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERSHIP",
        "first_name": "CHARLOTTE",
        "middle_name": "ELA",
        "name_prefix": "Ms.",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-15",
        "last_updated": "2011-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "OR",
            "license": "389452",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

Verify at the official NPI Registry.