NPIMap

Individual provider Active NPI

Tina L Waits, OTRL

  • Occupational Therapist
  • Georgetown, KY
National Provider Identifier
1477757763
Registry record updated Nov 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
133079 Issued in KY
Practice address
101 Windsor Path
Georgetown, KY 40324
Phone
(859) 422-4568
Fax
(859) 757-4649
NPI assigned
Jun 12, 2007
Last updated
Nov 12, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X R4758 KY
Occupational Therapist 225X00000X 133079 KY Primary

Addresses

Primary practice location

101 Windsor Path
Georgetown, KY 40324

Mailing address

3480 Yorkshire Medical Park
Lexington, KY 40509
Phone (859) 422-4568

Other identifiers 2

IdentifierTypeStateIssuer
133079OtherKYKY STATE LICENSE
7100201870MedicaidKY

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
R4758KYMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Drayer Physical Therapy Institute LLC Occupational Therapist Past Accepting new patients
PT Pros, Inc. Past Accepting new patients
Bluegrass Orthopaedics PSC Occupational Therapist Past Accepting new patients
Kentucky Hand and Physical Therapy BC LLC Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.61440

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1181606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573516800000",
    "number": "1477757763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3480 YORKSHIRE MEDICAL PARK",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "40509",
            "telephone_number": "859-422-4568",
            "fax_number": "859-757-4649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 WINDSOR PATH",
            "city": "GEORGETOWN",
            "state": "KY",
            "postal_code": "40324",
            "telephone_number": "859-422-4568",
            "fax_number": "859-757-4649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAITS",
        "first_name": "TINA",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "OTRL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-12",
        "last_updated": "2019-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "KY",
            "license": "R4758",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "KY",
            "license": "133079",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KY STATE LICENSE",
            "identifier": "133079",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100201870",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2019; 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.