Omar Villa, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

OTA4506 Issued in NM

Practice address

224 E Nizhoni Blvd
Gallup, NM 87301-5744

Phone

(505) 863-9551

NPI assigned

Dec 28, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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": "1640649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640649600000",
    "number": "1760142038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224 E NIZHONI BLVD",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873015744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 E NIZHONI BLVD",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873015744",
            "telephone_number": "505-863-9551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VILLA",
        "first_name": "OMAR",
        "credential": "COTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-12-28",
        "last_updated": "2021-12-28",
        "certification_date": "2021-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "NM",
            "license": "OTA4506",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "Genesishealthcare",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "224 E Nizhoni Blvd",
            "city": "Gallup",
            "state": "NM",
            "country_code": "US",
            "postal_code": "873015744",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nicole Lea Vest
• Jessica Vickers
• Marlene Vickery, RN
• Grace Victor, PHARMD
• Stephanie Vigil
• Marisol Villacis
• Chandler R Villegas, RN
• Juvie May Villegas
• Anthony Vitali, DMD
• Judith Von Wald, RN

• Occupational Therapy Assistant in Gallup, NM
• Providers in Gallup, NM by specialty
• Occupational Therapy Assistant in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2021; 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.