Active NPI
Phyllis Houston Dishner, COTA/L
- Occupational Therapy Assistant
- Wise, VA
National Provider Identifier
1689185969
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 0131000931
- Practice address
- 628 Lake St NE
Wise, VA 24293-7919 - Phone
- (276) 275-1500
- NPI assigned
- Oct 13, 2017
- Last updated
- Oct 13, 2017
- Sex
- Female
- Sole proprietor
- No
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 | 0131000931 | VA | Primary |
Addresses
Primary practice location
628 Lake St NE
Wise, VA 24293-7919
Mailing address
518 Powell Ave E
Big Stone Gap, VA 24219-2346
Phone (276) 275-1500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8409140 | Other | VA | INSURANCE BROKER |
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 |
|---|---|---|---|
| 0131000931 | VA | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1507852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1507852800000",
"number": "1689185969",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "518 POWELL AVE E",
"city": "BIG STONE GAP",
"state": "VA",
"postal_code": "242192346",
"telephone_number": "276-275-1500",
"fax_number": "276-275-1500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "628 LAKE ST NE",
"city": "WISE",
"state": "VA",
"postal_code": "242937919",
"telephone_number": "276-275-1500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DISHNER",
"first_name": "PHYLLIS",
"middle_name": "HOUSTON",
"name_prefix": "Mrs.",
"credential": "COTA/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-10-13",
"last_updated": "2017-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "VA",
"license": "0131000931",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INSURANCE BROKER",
"identifier": "8409140",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wise, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.