Individual provider Active NPI

Bethany Michelle Lasella, OTR

  • Occupational Therapist
  • Milford, CT
National Provider Identifier
1366019093
Registry record updated Nov 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
5631 Issued in CT
Practice address
209 Cherry St
Milford, CT 06460-3501
Phone
(203) 874-5437
NPI assigned
Jun 10, 2021
Last updated
Nov 23, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2021

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 5631 CT Primary

Addresses

Primary practice location

209 Cherry St
Milford, CT 06460-3501

Mailing address

1 Stiles Rd
Ste 203
Salem, NH 03079-4804
Phone (855) 390-7774

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
14195MAMDGeneral Practice Dentistry
5631CTMDOccupational Therapist

NPI Registry JSON

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

{
    "created_epoch": "1623283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637625600000",
    "number": "1366019093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 STILES RD",
            "address_2": "STE 203",
            "city": "SALEM",
            "state": "NH",
            "postal_code": "030794804",
            "telephone_number": "855-390-7774",
            "fax_number": "855-734-4666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 CHERRY ST",
            "city": "MILFORD",
            "state": "CT",
            "postal_code": "064603501",
            "telephone_number": "203-874-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LASELLA",
        "first_name": "BETHANY",
        "middle_name": "MICHELLE",
        "credential": "OTR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-10",
        "last_updated": "2021-11-23",
        "certification_date": "2021-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CT",
            "license": "5631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2021; 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.