Active NPI
Amanda Grace Cedillo, OTR L
- Occupational Therapist
- Raleigh, NC
National Provider Identifier
1316002991
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 5919
- Practice address
- 4201 Lake Boone Trail
Suite 4
Raleigh, NC 27607-7511 - Phone
- (919) 781-4434
- Fax
- (919) 781-5851
- NPI assigned
- Dec 26, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | |||
| Occupational Therapist | 225X00000X | 5919 | NC | Primary |
Addresses
Primary practice location
4201 Lake Boone Trail
Suite 4
Raleigh, NC 27607-7511
Mailing address
4201 Lake Boone Trail
Suite 4
Raleigh, NC 27607-7511
Phone (919) 781-4434
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 187639 | Other | MEDCOST | |
| 7404775 | Other | AETNA | |
| 1413T | Other | BCBS | |
| 6400040 | Other | UNITED HEATHCARE | |
| 7301902 | Medicaid | NC | |
| 8300041K | Medicaid | NC |
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 |
|---|---|---|---|
| 5919 | NC | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Therapy Associates | Community Health Worker | Past | Accepting new patients |
Organizations & group practices 1
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": "1167091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1212710400000",
"number": "1316002991",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4201 LAKE BOONE TRAIL",
"address_2": "SUITE 4",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276077511",
"telephone_number": "919-781-4434",
"fax_number": "919-781-5851"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4201 LAKE BOONE TRAIL",
"address_2": "SUITE 4",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276077511",
"telephone_number": "919-781-4434",
"fax_number": "919-781-5851"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CEDILLO",
"first_name": "AMANDA",
"middle_name": "GRACE",
"credential": "OTR L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-26",
"last_updated": "2008-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NC",
"license": "5919",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDCOST",
"identifier": "187639",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7404775",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "1413T",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEATHCARE",
"identifier": "6400040",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7301902",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8300041K",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.