Active NPI
Joseph Mangunary Victorio, MOT / OTR / L
- Occupational Therapist
- Seattle, WA
National Provider Identifier
1528318946
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 0763
- Practice address
- 1660 Columbian Way South
Seattle, WA 98144 - Phone
- (206) 762-1010
- NPI assigned
- Sep 13, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 0763 | NV | Primary |
| Occupational Therapist | 225X00000X | 13362 | CA | |
| Occupational Therapist | 225X00000X | 1064302 | MD |
Addresses
Primary practice location
1660 Columbian Way South
Seattle, WA 98144
Mailing address
6247 Carson Hills Ave
Las Vegas, NV 89139
Phone (702) 412-9171
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 |
|---|---|---|---|
| 13362 | CA | MD | Occupational Therapist |
| 1064302 | MD | MD | Occupational Therapist |
| 0763 | NV | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1347494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410998400000",
"number": "1528318946",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6247 CARSON HILLS AVE",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "89139",
"telephone_number": "702-412-9171"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1660 COLUMBIAN WAY SOUTH",
"city": "SEATTLE",
"state": "WA",
"postal_code": "98144",
"telephone_number": "206-762-1010"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VICTORIO",
"first_name": "JOSEPH",
"middle_name": "MANGUNARY",
"credential": "MOT / OTR / L",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-09-13",
"last_updated": "2014-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NV",
"license": "0763",
"primary": true
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "13362",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MD",
"license": "1064302",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.