Active NPI
Ray Lavarias Reola, OT
- Mental Health Occupational Therapist
- Tacoma, WA
National Provider Identifier
1417532664
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Occupational Therapist
- License
- 20148
- Practice address
- 9040 Jackson Ave
Tacoma, WA 98431-6625 - Phone
- (615) 270-6958
- NPI assigned
- Mar 9, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Occupational Therapist | 225XM0800X | 20148 | CA | Primary |
| Neurorehabilitation Occupational Therapist | 225XN1300X | 20148 | CA | |
| Occupational Therapist | 225X00000X | 20148 | CA | |
| Physical Rehabilitation Occupational Therapist | 225XP0019X | 20148 | CA | |
| Human Factors Occupational Therapist | 225XH1300X | 20148 | CA |
Addresses
Primary practice location
9040 Jackson Ave
Tacoma, WA 98431-6625
Mailing address
3750 W San Jose Ave Apt 107
Fresno, CA 93711-6625
Phone (626) 383-6390
Other practice location 1
308 Tacoma Ave S Apt 613
Tacoma, WA 98402-2645
Phone (626) 383-6390
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 |
|---|---|---|---|
| 20148 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1615248000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719878400000",
"number": "1417532664",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3750 W SAN JOSE AVE APT 107",
"city": "FRESNO",
"state": "CA",
"postal_code": "937116625",
"telephone_number": "626-383-6390"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9040 JACKSON AVE",
"city": "TACOMA",
"state": "WA",
"postal_code": "984316625",
"telephone_number": "615-270-6958"
}
],
"practiceLocations": [
{
"address_1": "308 Tacoma Ave S Apt 613",
"address_purpose": "LOCATION",
"city": "Tacoma",
"state": "WA",
"postal_code": "984022645",
"country_code": "US",
"telephone_number": "626-383-6390",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "REOLA",
"first_name": "RAY",
"middle_name": "LAVARIAS",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-03-09",
"last_updated": "2024-07-02",
"certification_date": "2024-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "225XM0800X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Mental Health",
"state": "CA",
"license": "20148",
"primary": true
},
{
"code": "225XN1300X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Neurorehabilitation",
"state": "CA",
"license": "20148",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "20148",
"primary": false
},
{
"code": "225XP0019X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Physical Rehabilitation",
"state": "CA",
"license": "20148",
"primary": false
},
{
"code": "225XH1300X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Human Factors",
"state": "CA",
"license": "20148",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.