Active NPI
Stacy Waters, COTA/L
- Occupational Therapy Assistant
- Dodge City, KS
National Provider Identifier
1558730564
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 18-01135
- Practice address
- 200 Campus Dr
Dodge City, KS 67801-2760 - Phone
- (620) 225-1928
- Fax
- (620) 408-9058
- NPI assigned
- Sep 20, 2015
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 18-01135 | KS | Primary |
Addresses
Primary practice location
200 Campus Dr
Dodge City, KS 67801-2760
Mailing address
200 Campus Dr
Dodge City, KS 67801-2760
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 |
|---|---|---|---|
| 18-01135 | KS | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1442707200000",
"number": "1558730564",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 CAMPUS DR",
"city": "DODGE CITY",
"state": "KS",
"postal_code": "678012760"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 CAMPUS DR",
"city": "DODGE CITY",
"state": "KS",
"postal_code": "678012760",
"telephone_number": "620-225-1928",
"fax_number": "620-408-9058"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATERS",
"first_name": "STACY",
"credential": "COTA/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-09-20",
"last_updated": "2015-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "KS",
"license": "18-01135",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dodge City, KS
- Walmart, Inc. (Walmart pharmacy 10-3164)
- Wade Cody Walters, DDS
- Emalea Raeannah Nicole Warden
- Kathleen Joan Warner-Long, MED, LCPC
- Robert E Warrick, D.O.
- Tyler N Weenig, DMD
- Western Plains Physician Practices LLC (Western Plains Eye Associates)
- Western Plains Physician Practices LLC (Southwest Kansas Orthopedics)
- Western Plains Physician Practices LLC (Dodge City Surgical Services)
- Western Plains Physician Practices, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.