Active NPI
Andi Katelyn Otto, COTA
- Occupational Therapy Assistant
- Waco, TX
National Provider Identifier
1881188423
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 214-510
- Practice address
- 5400 Laurel Lake Dr
Waco, TX 76710-2835 - Phone
- (254) 774-4644
- NPI assigned
- Jun 18, 2018
- 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 | 214-510 | TX | Primary |
Addresses
Primary practice location
5400 Laurel Lake Dr
Waco, TX 76710-2835
Mailing address
4578 Leroy Pkwy
Elm Mott, TX 76640-3551
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 |
|---|---|---|---|
| 214-510 | TX | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1529280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529280000000",
"number": "1881188423",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4578 LEROY PKWY",
"city": "ELM MOTT",
"state": "TX",
"postal_code": "766403551"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5400 LAUREL LAKE DR",
"city": "WACO",
"state": "TX",
"postal_code": "767102835",
"telephone_number": "254-774-4644"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OTTO",
"first_name": "ANDI",
"middle_name": "KATELYN",
"name_prefix": "Miss",
"credential": "COTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-06-18",
"last_updated": "2018-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "TX",
"license": "214-510",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waco, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 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.