NPIMap

Organization Active NPI

Supplemental Healthcare

  • Occupational Therapy Assistant
  • Tigard, OR
National Provider Identifier
1619377785
Registry record updated Aug 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
314621 Issued in OR
Legal business name
SUPPLEMENTAL HEALTHCARE
Practice address
7320 SW Hunziker St Ste 203
Tigard, OR 97223-2301
Phone
(888) 317-1019
NPI assigned
Aug 26, 2014
Last updated
Aug 26, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2014

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

Authorized official

Name
Devyn Hall
Title
Cota
Phone
(520) 975-7573

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 314621 OR Primary

Addresses

Primary practice location

7320 SW Hunziker St Ste 203
Tigard, OR 97223-2301

Mailing address

7320 SW Hunziker, Suite 203
Tigard, OR 97223-2301
Phone (888) 317-1019

Other identifiers 1

IdentifierTypeStateIssuer
314621MedicaidOR

National Provider Directory

National Provider Directory
Tax ID family
Supplmental Health Care42 organizations share this tax ID, including this one

Other organizations with this tax ID 41

Organizations that report the same tax identification number in the National Provider Directory.

View all 41

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1409011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409011200000",
    "number": "1619377785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7320 SW HUNZIKER, SUITE 203",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972232301",
            "telephone_number": "888-317-1019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7320 SW HUNZIKER ST STE 203",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972232301",
            "telephone_number": "888-317-1019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPPLEMENTAL HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-26",
        "last_updated": "2014-08-26",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "DEVYN",
        "authorized_official_title_or_position": "COTA",
        "authorized_official_telephone_number": "520-975-7573"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "OR",
            "license": "314621",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "314621",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tigard, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 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.

Verify at the official NPI Registry.