Destiny Almajo Maben, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

2022010499 Issued in MO

Practice address

1101 W Clay Rd
Versailles, MO 65084-1177

Phone

(573) 539-3065

NPI assigned

Apr 12, 2022

Last updated

Apr 12, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1649721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649721600000",
    "number": "1669114328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1503 INDEPENDENCE RD",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012639",
            "telephone_number": "573-368-8559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 W CLAY RD",
            "city": "VERSAILLES",
            "state": "MO",
            "postal_code": "650841177",
            "telephone_number": "573-539-3065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MABEN",
        "first_name": "DESTINY",
        "middle_name": "ALMAJO",
        "credential": "COTA/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-12",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "MO",
            "license": "2022010499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapy Assistant in Versailles, MO
• Providers in Versailles, MO by specialty
• Occupational Therapy Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2022; 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.