Active NPI
Nicholas Scott Wahlstrand, OTR
- Occupational Therapist
- Lakeport, CA
National Provider Identifier
1730792896
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 20478
- Practice address
- 1291 Craig Ave
Lakeport, CA 95453-5704 - Phone
- (707) 263-6382
- NPI assigned
- Aug 28, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 Therapist | 225X00000X | 20478 | CA | Primary |
Addresses
Primary practice location
1291 Craig Ave
Lakeport, CA 95453-5704
Mailing address
2509 9TH Ave S
Grand Forks, ND 58201-4121
Phone (305) 394-7655
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 |
|---|---|---|---|
| 20478 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598572800000",
"number": "1730792896",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2509 9TH AVE S",
"city": "GRAND FORKS",
"state": "ND",
"postal_code": "582014121",
"telephone_number": "305-394-7655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1291 CRAIG AVE",
"city": "LAKEPORT",
"state": "CA",
"postal_code": "954535704",
"telephone_number": "707-263-6382"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAHLSTRAND",
"first_name": "NICHOLAS",
"middle_name": "SCOTT",
"name_prefix": "Mr.",
"credential": "OTR",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-08-28",
"last_updated": "2020-08-28",
"certification_date": "2020-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "20478",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakeport, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.