Active NPI
Mary Kathryn Vanderworp, O.T.
- Occupational Therapist
- Phoenix, AZ
National Provider Identifier
1043545817
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 0409
- Practice address
- 6115 N 12TH St
Unit #3
Phoenix, AZ 85014-1717 - Phone
- (602) 993-4191
- NPI assigned
- Oct 12, 2009
- Sex
- Female
- Sole proprietor
- Yes
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 Therapist | 225X00000X | 0409 | AZ | Primary |
Addresses
Primary practice location
6115 N 12TH St
Unit #3
Phoenix, AZ 85014-1717
Mailing address
6115 N 12TH St
Unit #3
Phoenix, AZ 85014-1717
Phone (602) 993-4191
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 |
|---|---|---|---|
| 0409 | AZ | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1255305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1258502400000",
"number": "1043545817",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6115 N 12TH ST",
"address_2": "UNIT #3",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850141717",
"telephone_number": "602-993-4191"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6115 N 12TH ST",
"address_2": "UNIT #3",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850141717",
"telephone_number": "602-993-4191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDERWORP",
"first_name": "MARY",
"middle_name": "KATHRYN",
"name_prefix": "Ms.",
"credential": "O.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-10-12",
"last_updated": "2009-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "AZ",
"license": "0409",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.