Active NPI
Coby Cedarholm, COTA/L
- Occupational Therapy Assistant
- Overland Park, KS
National Provider Identifier
1982116356
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 2015018415
- Practice address
- 5100 Indian Creek Pkwy
Overland Park, KS 66207-4115 - Phone
- (913) 967-5222
- NPI assigned
- Oct 25, 2017
- Last updated
- Oct 25, 2017
- Sex
- Male
- 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 | 2015018415 | MO | Primary |
Addresses
Primary practice location
5100 Indian Creek Pkwy
Overland Park, KS 66207-4115
Mailing address
545 Jefferson Cir
Liberty, MO 64068-1440
Phone (816) 679-4287
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 |
|---|---|---|---|
| 2015018415 | MO | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1508889600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1508889600000",
"number": "1982116356",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "545 JEFFERSON CIR",
"city": "LIBERTY",
"state": "MO",
"postal_code": "640681440",
"telephone_number": "816-679-4287"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5100 INDIAN CREEK PKWY",
"city": "OVERLAND PARK",
"state": "KS",
"postal_code": "662074115",
"telephone_number": "913-967-5222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CEDARHOLM",
"first_name": "COBY",
"credential": "COTA/L",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-10-25",
"last_updated": "2017-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "MO",
"license": "2015018415",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Overland Park, KS
- Timothy B Cavanaugh, MD
- Hannah Caviness, OTR
- CCRC of Cedar Rapids, LLC (Terrace Glen Village)
- CCRC of Overland Park, LLC (Colonial Village)
- Cecily a. Clark-Ganheart, M.D., P.a. (Conceptual Health)
- Ashley Celis, ANP
- Centered Counseling, LLC
- Centered Mind LLC
- Centerwell Certified Healthcare Corp. (CenterWell Home Health)
- Centerwell Senior Primary Care KS PA (Partners in Primary Care- Overland Park)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.