Individual provider Active NPI

Debra L Omara

  • Occupational Therapist
  • O Fallon, MO
National Provider Identifier
1811027733
Registry record updated Feb 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
000820 Issued in MO
Practice address
Ft Zumwalt R-II
110 Virgil St
O Fallon, MO 63366-2637
Phone
(636) 272-1059
Fax
(636) 980-1946
NPI assigned
Mar 7, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 000820 MO Primary

Addresses

Primary practice location

Ft Zumwalt R-II
110 Virgil St
O Fallon, MO 63366-2637

Mailing address

110 Virgil St
O Fallon, MO 63366-2637
Phone (636) 272-1059

Other identifiers 1

IdentifierTypeStateIssuer
473366714MedicaidMO

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

LicenseStateTypeSpecialty
000820MOMDOccupational Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1235001600000",
    "number": "1811027733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 VIRGIL ST",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633662637",
            "telephone_number": "636-272-1059",
            "fax_number": "636-980-1946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "FT ZUMWALT R-II",
            "address_2": "110 VIRGIL ST",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633662637",
            "telephone_number": "636-272-1059",
            "fax_number": "636-980-1946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OMARA",
        "first_name": "DEBRA",
        "middle_name": "L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-07",
        "last_updated": "2009-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MO",
            "license": "000820",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "473366714",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in O Fallon, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2009; 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.