Teri Nyblom X, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

OC 60601017 Issued in WA

Practice address

2830 I St NE
Auburn, WA 98002-2410

Phone

(253) 394-0844

NPI assigned

Nov 10, 2015

Last updated

Nov 10, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Teri Nyblom Professional name

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": "1447113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447113600000",
    "number": "1972976033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9916 62ND AVENUE CT E",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983734174",
            "telephone_number": "253-226-0217",
            "fax_number": "253-848-4269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2830 I ST NE",
            "city": "AUBURN",
            "state": "WA",
            "postal_code": "980022410",
            "telephone_number": "253-394-0844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NYBLOM",
        "first_name": "TERI",
        "name_suffix": "X",
        "credential": "COTA/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-11-10",
        "last_updated": "2015-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "WA",
            "license": "OC 60601017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TERI",
            "last_name": "NYBLOM",
            "credential": "COTA/L",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Occupational Therapy Assistant in Auburn, WA
• Providers in Auburn, WA by specialty
• Occupational Therapy Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2015; 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.