Active NPI
Kate Costelloe, OTRL
- Pediatric Occupational Therapist
- Vancouver, WA
National Provider Identifier
1346361748
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- Practice address
- 13501 NE 28TH St
Vancouver, WA 98682-8091 - Phone
- (360) 604-6700
- NPI assigned
- Apr 3, 2007
- Last updated
- Jan 23, 2013
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT00002913 | WA | |
| Pediatric Occupational Therapist | 225XP0200X | NU | Primary |
Addresses
Primary practice location
13501 NE 28TH St
Vancouver, WA 98682-8091
Mailing address
5110 NE Glisan St
Portland, OR 97213-2940
Phone (360) 888-6989
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7683444 | Medicaid | WA |
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 |
|---|---|---|---|
| OT00002913 | WA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358899200000",
"number": "1346361748",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5110 NE GLISAN ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972132940",
"telephone_number": "360-888-6989"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13501 NE 28TH ST",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986828091",
"telephone_number": "360-604-6700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COSTELLOE",
"first_name": "KATE",
"credential": "OTRL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-03",
"last_updated": "2013-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WA",
"license": "OT00002913",
"primary": false
},
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7683444",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.