Active NPI
Caitlynn Southerland, CTRS
- Occupational Therapist
- Tonasket, WA
National Provider Identifier
1548794324
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT61109008
- Practice address
- 203 S Western Ave
Tonasket, WA 98855-8803 - Phone
- (509) 486-2151
- NPI assigned
- Apr 18, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | 69003 | WA | |
| Occupational Therapist | 225X00000X | OT61109008 | WA | Primary |
Addresses
Primary practice location
203 S Western Ave
Tonasket, WA 98855-8803
Mailing address
203 S. Western Ave
C/O: Credentialing
Tonasket, WA 98855
Phone (509) 486-3144
Other practice location 1
3754 W Indian Trail Rd
Spokane, WA 99208-4736
Phone (360) 624-8636
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60731842 | Other | WA | WASHINGTON STATE DEPARTMENT OF HEALTH RECREATION THERAPIST REGISTRATION |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 69003 | WA | MD | Recreation Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1492473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705881600000",
"number": "1548794324",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "203 S. WESTERN AVE",
"address_2": "C/O: CREDENTIALING",
"city": "TONASKET",
"state": "WA",
"postal_code": "98855",
"telephone_number": "509-486-3144"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "203 S WESTERN AVE",
"city": "TONASKET",
"state": "WA",
"postal_code": "988558803",
"telephone_number": "509-486-2151"
}
],
"practiceLocations": [
{
"address_1": "3754 W Indian Trail Rd",
"address_purpose": "LOCATION",
"city": "Spokane",
"state": "WA",
"postal_code": "992084736",
"country_code": "US",
"telephone_number": "360-624-8636",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SOUTHERLAND",
"first_name": "CAITLYNN",
"credential": "CTRS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-04-18",
"last_updated": "2024-01-22",
"certification_date": "2024-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "225800000X",
"taxonomy_group": "",
"desc": "Recreation Therapist",
"state": "WA",
"license": "69003",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WA",
"license": "OT61109008",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WASHINGTON STATE DEPARTMENT OF HEALTH RECREATION THERAPIST REGISTRATION",
"identifier": "60731842",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tonasket, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 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.