Active NPI
Mary Bottom, COTA
- Occupational Therapy Assistant
- Palm Coast, FL
National Provider Identifier
1598031221
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- OTA 10272
- Practice address
- 105 Fenimore LN
Palm Coast, FL 32137-9169 - Phone
- (321) 604-6517
- NPI assigned
- Mar 27, 2012
- Sex
- Female
- Sole proprietor
- Yes
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 | OTA 10272 | FL | Primary |
Addresses
Primary practice location
105 Fenimore LN
Palm Coast, FL 32137-9169
Mailing address
105 Fenimore LN
Palm Coast, FL 32137-9169
Phone (321) 604-6517
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 |
|---|---|---|---|
| OTA 10272 | FL | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1332806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1332806400000",
"number": "1598031221",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 FENIMORE LN",
"city": "PALM COAST",
"state": "FL",
"postal_code": "321379169",
"telephone_number": "321-604-6517"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 FENIMORE LN",
"city": "PALM COAST",
"state": "FL",
"postal_code": "321379169",
"telephone_number": "321-604-6517"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOTTOM",
"first_name": "MARY",
"credential": "COTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-03-27",
"last_updated": "2012-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "FL",
"license": "OTA 10272",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palm Coast, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.