Connie Colleen Wyatt, OTR/L

Primary specialty

Environmental Modification Occupational TherapistTaxonomy code 225XE0001X

License

60850227 Issued in WA

Practice address

4815 Sharpe Rd
Anacortes, WA 98221-8403

Phone

(360) 770-1752

NPI assigned

Jan 7, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

PNW Home for Life PLLCGroup PAC ID 8921436726, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• PNW Home for Life PLLC

  • Environmental Modification Occupational Therapist
  • Anacortes, WA
  • NPI 1649800608
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1578355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578355200000",
    "number": "1992345011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4815 SHARPE RD",
            "city": "ANACORTES",
            "state": "WA",
            "postal_code": "982218403",
            "telephone_number": "360-770-1752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4815 SHARPE RD",
            "city": "ANACORTES",
            "state": "WA",
            "postal_code": "982218403",
            "telephone_number": "360-770-1752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYATT",
        "first_name": "CONNIE",
        "middle_name": "COLLEEN",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-07",
        "last_updated": "2020-01-07",
        "certification_date": "2020-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XG0600X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Gerontology",
            "state": "WA",
            "license": "60850227",
            "primary": false
        },
        {
            "code": "225XP0019X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Physical Rehabilitation",
            "state": "WA",
            "license": "60850227",
            "primary": false
        },
        {
            "code": "225XE0001X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Environmental Modification",
            "state": "WA",
            "license": "60850227",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OCCUPATIONAL THERAPIST LICENSE",
            "identifier": "60850227",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ryan Wisler, MD
• Sheena Marie Wisler, MD
• Rachael Sarah Witter
• Jacqueline Wittman, M.S.
• Rosann Mary Wuebbels, LMP
• Tommy Yan
• Helen Yingqing Young, M.D.
• Veronica Young
• Abigail L Yrorita, LMHCA

• Occupational Therapist in Anacortes, WA
• Providers in Anacortes, WA by specialty
• Occupational Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.