Active NPI
Katessia Leann Shelton, COTA/L
- Occupational Therapy Assistant
- Johnson City, TN
National Provider Identifier
1710437629
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 2782
- Practice address
- 401 E Main St Ste 4
Johnson City, TN 37601-4891 - Phone
- (423) 722-2062
- Fax
- (243) 722-2062
- NPI assigned
- Oct 4, 2016
- 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 | 2782 | TN | Primary |
Addresses
Primary practice location
401 E Main St Ste 4
Johnson City, TN 37601-4891
Mailing address
401 E Main St Ste 4
Johnson City, TN 37601-4891
Phone (423) 722-2062
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 |
|---|---|---|---|
| 2782 | TN | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physical Therapy Services, P.a. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinic/Center
- Elizabethton, TN
- NPI 1831109867
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1475539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475539200000",
"number": "1710437629",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 E MAIN ST STE 4",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376014891",
"telephone_number": "423-722-2062",
"fax_number": "243-722-2062"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 E MAIN ST STE 4",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376014891",
"telephone_number": "423-722-2062",
"fax_number": "243-722-2062"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHELTON",
"first_name": "KATESSIA",
"middle_name": "LEANN",
"name_prefix": "Mrs.",
"credential": "COTA/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-10-04",
"last_updated": "2016-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "TN",
"license": "2782",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Johnson City, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.