Individual provider Active NPI

Judith Tvergyak, COTA/L

  • Occupational Therapy Assistant
  • Chardon, OH
National Provider Identifier
1669896593
Registry record updated Feb 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
OTA. 03196 Issued in OH
Practice address
470 Center St
BLDG #2
Chardon, OH 44024-1098
Phone
(440) 279-1709
NPI assigned
Feb 12, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 12, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X OTA. 03196 OH Primary

Addresses

Primary practice location

470 Center St
BLDG #2
Chardon, OH 44024-1098

Mailing address

13007 Woodin Rd
Chardon, OH 44024-9180
Phone (440) 477-7324

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

LicenseStateTypeSpecialty
OTA. 03196OHMDOccupational Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1392163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392163200000",
    "number": "1669896593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13007 WOODIN RD",
            "city": "CHARDON",
            "state": "OH",
            "postal_code": "440249180",
            "telephone_number": "440-477-7324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "470 CENTER ST",
            "address_2": "BLDG #2",
            "city": "CHARDON",
            "state": "OH",
            "postal_code": "440241098",
            "telephone_number": "440-279-1709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TVERGYAK",
        "first_name": "JUDITH",
        "credential": "COTA/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-02-12",
        "last_updated": "2014-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "OH",
            "license": "OTA. 03196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chardon, OH

Sources for this page

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