Individual provider Active NPI

Rebecca Judy Mermod, COTA

  • Occupational Therapy Assistant
  • Port Angeles, WA
National Provider Identifier
1407053077
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
OC00000662 Issued in WA
Practice address
1116 E Lauridsen Blvd
Port Angeles, WA 98362-6640
Phone
(360) 452-9206
NPI assigned
Jun 28, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X OC00000662 WA Primary

Addresses

Primary practice location

1116 E Lauridsen Blvd
Port Angeles, WA 98362-6640

Mailing address

395 Fort Gate Rd
Nordland, WA 98358-9516
Phone (360) 379-1881

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

LicenseStateTypeSpecialty
OC00000662WAMDOccupational Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1182988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407053077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "395 FORT GATE RD",
            "city": "NORDLAND",
            "state": "WA",
            "postal_code": "983589516",
            "telephone_number": "360-379-1881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1116 E LAURIDSEN BLVD",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983626640",
            "telephone_number": "360-452-9206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERMOD",
        "first_name": "REBECCA",
        "middle_name": "JUDY",
        "name_prefix": "Mrs.",
        "credential": "COTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "WA",
            "license": "OC00000662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Angeles, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.