Active NPI
Jennifer Wall, COTA
- Occupational Therapy Assistant
- Pullman, WA
National Provider Identifier
1760901037
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- OC60506537
- Practice address
- 1310 NW Deane St
Pullman, WA 99163-3705 - Phone
- (506) 332-1566
- NPI assigned
- Sep 18, 2017
- Sex
- Female
- 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 Therapy Assistant | 224Z00000X | OC60506537 | WA | Primary |
Addresses
Primary practice location
1310 NW Deane St
Pullman, WA 99163-3705
Mailing address
1010 S 336TH St Ste 210
Federal Way, WA 98003-7354
Phone (866) 835-8091
Other practice location 1
1010 S 336th St Ste 210
Federal Way, WA 98003-7354
Phone (866) 835-8091
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 |
|---|---|---|---|
| OC60506537 | WA | MD | Occupational Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Supplemental Healthcare | Past | Accepting new patients | |
| SHC Services Inc. | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Skilled Nursing Facility
- Federal Way, WA
- NPI 1124306725
-
- Home Health Agency
- Federal Way, WA
- NPI 1932487535
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505692800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1760901037",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1010 S 336TH ST STE 210",
"city": "FEDERAL WAY",
"state": "WA",
"postal_code": "980037354",
"telephone_number": "866-835-8091"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1310 NW DEANE ST",
"city": "PULLMAN",
"state": "WA",
"postal_code": "991633705",
"telephone_number": "506-332-1566"
}
],
"practiceLocations": [
{
"address_1": "1010 S 336th St Ste 210",
"address_purpose": "LOCATION",
"city": "Federal Way",
"state": "WA",
"postal_code": "980037354",
"country_code": "US",
"telephone_number": "866-835-8091",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WALL",
"first_name": "JENNIFER",
"credential": "COTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-09-18",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "WA",
"license": "OC60506537",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pullman, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.