Active NPI
Stacy Camille Costa, OTR/L
- Occupational Therapist
- Philadelphia, PA
National Provider Identifier
1407159700
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OC009892
- Practice address
- 2121 Carpenter St
Unit 2
Philadelphia, PA 19146-2515 - Phone
- (215) 687-1908
- NPI assigned
- Dec 9, 2010
- Last updated
- Dec 9, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OC009892 | PA | Primary |
Addresses
Primary practice location
2121 Carpenter St
Unit 2
Philadelphia, PA 19146-2515
Mailing address
2121 Carpenter St
Unit 2
Philadelphia, PA 19146-2515
Phone (215) 687-1908
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 |
|---|---|---|---|
| OC009892 | PA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1291852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1291852800000",
"number": "1407159700",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2121 CARPENTER ST",
"address_2": "UNIT 2",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191462515",
"telephone_number": "215-687-1908"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2121 CARPENTER ST",
"address_2": "UNIT 2",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191462515",
"telephone_number": "215-687-1908"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COSTA",
"first_name": "STACY",
"middle_name": "CAMILLE",
"name_prefix": "Mrs.",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-12-09",
"last_updated": "2010-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "PA",
"license": "OC009892",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.