Active NPI
Mandisa Pettiford, OTA
- Occupational Therapy Assistant
- Belton, MO
National Provider Identifier
1982908836
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 2011006042
- Practice address
- 17134 Bel Ray PL
Belton, MO 64012-5331 - Phone
- (816) 318-0436
- Fax
- (816) 318-0437
- NPI assigned
- Jan 7, 2011
- 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 | 2011006042 | MO | Primary |
Addresses
Primary practice location
17134 Bel Ray PL
Belton, MO 64012-5331
Mailing address
17134 Bel Ray PL
Belton, MO 64012-5331
Phone (816) 318-0436
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 |
|---|---|---|---|
| 2011006042 | MO | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1294358400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1351123200000",
"number": "1982908836",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17134 BEL RAY PL",
"city": "BELTON",
"state": "MO",
"postal_code": "640125331",
"telephone_number": "816-318-0436",
"fax_number": "816-318-0437"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17134 BEL RAY PL",
"city": "BELTON",
"state": "MO",
"postal_code": "640125331",
"telephone_number": "816-318-0436",
"fax_number": "816-318-0437"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTIFORD",
"first_name": "MANDISA",
"credential": "OTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-01-07",
"last_updated": "2012-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "MO",
"license": "2011006042",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Belton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.