PNW Home for Life PLLC

Primary specialty

Environmental Modification Occupational TherapistTaxonomy code 225XE0001X

Legal business name

PNW HOME FOR LIFE PLLC

Practice address

4815 Sharpe Rd
Anacortes, WA 98221-8403

Phone

(360) 770-1752

NPI assigned

Jan 18, 2020

Last updated

Jan 18, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Connie Colleen Wyatt, OTR/LNPI 1992345011

Title

Occupational Therapist

Phone

(360) 770-1752

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Practitioners 3

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.

• Connie Colleen Wyatt, OTR/L

  • Environmental Modification Occupational Therapist
  • Anacortes, WA
  • NPI 1992345011
  Medicare reassignment Care Compare group NPD Authorized official
• Avery Caroline Bell

  • Occupational Therapist
  • Anacortes, WA
  • NPI 1760335509
  Medicare reassignment Care Compare group NPD
• Juli Elizabeth Stolpmann

  • Occupational Therapist
  • Hayward, CA
  • NPI 1346847936

  WA

  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1579305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579305600000",
    "number": "1649800608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4815 SHARPE RD",
            "city": "ANACORTES",
            "state": "WA",
            "postal_code": "982218403",
            "telephone_number": "360-770-1752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4815 SHARPE RD",
            "city": "ANACORTES",
            "state": "WA",
            "postal_code": "982218403",
            "telephone_number": "360-770-1752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PNW HOME FOR LIFE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-18",
        "last_updated": "2020-01-18",
        "certification_date": "2020-01-18",
        "status": "A",
        "authorized_official_last_name": "WYATT",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_middle_name": "COLLEEN",
        "authorized_official_title_or_position": "OCCUPATIONAL THERAPIST",
        "authorized_official_telephone_number": "360-770-1752",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225XE0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist, Environmental Modification",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adelynn Margaret Peterson
• Jon T Peterson, DO
• Amber Nicosia Phillips, RD
• Ronald A Pinson, DMD
• PNW Clinic
• Lauren Povoli, NP
• Jonathan Prescott, BCC, BCCC, BCPC
• Janine Hoisington Prichard, LMP
• Proliance Surgeons, Inc., P.S. (Proliance Surgeons Skagit Northwest Orthopedics)
• Proliance Surgeons, Inc., P.S. (Proliance Surgeons Skagit Northwest Orthopedics)

• Occupational Therapist in Anacortes, WA
• Providers in Anacortes, WA by specialty
• Occupational Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.