Individual provider Active NPI

Stacy Kosha, OTR/L

  • Occupational Therapist
  • Bryan, OH
National Provider Identifier
1407278666
Registry record updated Jan 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OT-4038 Issued in OH
Practice address
1433 N Main St
Bryan, OH 43506-1053
Phone
(419) 633-9191
NPI assigned
Jan 7, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2014

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 OT-4038 OH Primary

Addresses

Primary practice location

1433 N Main St
Bryan, OH 43506-1053

Mailing address

1440 Rays Dr
Bryan, OH 43506-9176
Phone (419) 636-5445

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160413001770 IN Practitioner - Occupational Therapist in Private Practice 1355660911 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OT-4038OHMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Healthpro Heritage Rehab & Fitness, LLC Occupational Therapist CurrentSince Feb 4, 2021 Accepting new patients
Healthpro Heritage Rehab & Fitness, LLC Occupational Therapist CurrentSince Feb 4, 2021 Accepting new patients
Cortlyn Therapy, PC Occupational Therapist CurrentSince Jul 13, 2021 Accepting new patients

Locations

7125 Janes Ave
Ste 300
Woodridge, IL 60517
Phone (630) 413-5817

1675 W 7th St
Auburn, IN 46706
Phone (260) 247-6632

300 Medical Pkwy
Lakeway, TX 78738
Phone (737) 263-0448

Organizations & group practices 4

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": "1389052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389052800000",
    "number": "1407278666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1440 RAYS DR",
            "city": "BRYAN",
            "state": "OH",
            "postal_code": "435069176",
            "telephone_number": "419-636-5445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1433 N MAIN ST",
            "city": "BRYAN",
            "state": "OH",
            "postal_code": "435061053",
            "telephone_number": "419-633-9191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSHA",
        "first_name": "STACY",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-07",
        "last_updated": "2014-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "OH",
            "license": "OT-4038",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bryan, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.