Krista Ruth Bock Mangan

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

0560004157 Issued in IL

Practice address

10523 S Drake Ave
Chicago, IL 60655

Phone

(773) 429-0103

NPI assigned

Jan 5, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Krista Ruth Bock 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": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1043367592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12635 S 76TH AVE",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "60463",
            "telephone_number": "708-912-5788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10523 S DRAKE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60655",
            "telephone_number": "773-429-0103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOCK MANGAN",
        "first_name": "KRISTA",
        "middle_name": "RUTH",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "0560004157",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD IL",
            "identifier": "1626024",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTA",
            "last_name": "BOCK",
            "middle_name": "RUTH",
            "credential": "OTRL",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Christopher P Bocci, D.C.
• Piernicola Boccuni, M.D.
• Luciarita Boccuzzi, MD
• Candice Bochat, APRN, CNP
• Bruce S Bochner, M.D.
• Anna Lucia Bock
• Brittany Olivia Bock, PA-C
• Jerome V Bock, D.D.S
• Viola Bockenfeld
• Keith Bockhold, PHARMD

• Occupational Therapist in Chicago, IL
• Providers in Chicago, IL by specialty
• Occupational Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.