Individual provider Active NPI

Kari Ann Velasquez

  • Occupational Therapy Assistant
  • Georgetown, TX
National Provider Identifier
1053830091
Registry record updated Sep 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
212636 Issued in TX
Practice address
4402 Williams Dr Ste 115
Georgetown, TX 78628-1388
Phone
(512) 256-7627
NPI assigned
Sep 11, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 212636 TX Primary

Addresses

Primary practice location

4402 Williams Dr Ste 115
Georgetown, TX 78628-1388

Mailing address

4402 Williams Dr Ste 115
Georgetown, TX 78628-1388

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

LicenseStateTypeSpecialty
212636TXMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Jacqueline Kozak PastSince Nov 6, 2022 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1505088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505088000000",
    "number": "1053830091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4402 WILLIAMS DR STE 115",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786281388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4402 WILLIAMS DR STE 115",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786281388",
            "telephone_number": "512-256-7627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VELASQUEZ",
        "first_name": "KARI",
        "middle_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-11",
        "last_updated": "2017-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "TX",
            "license": "212636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 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.

Verify at the official NPI Registry.