Individual provider Active NPI

Kristina Lorraine Fenske-Vincent, OTR

  • Pediatric Occupational Therapist
  • South Pasadena, CA
National Provider Identifier
1063172997
Registry record updated Jun 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
License
OC018225 Issued in PA
Practice address
111 Peterson Ave
South Pasadena, CA 91030-4032
Phone
(570) 798-3490
NPI assigned
Dec 20, 2021
Last updated
Jun 3, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 3, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Occupational Therapist 225XP0200X OC018225 PA Primary

Addresses

Primary practice location

111 Peterson Ave
South Pasadena, CA 91030-4032

Mailing address

111 Peterson Ave
South Pasadena, CA 91030-4032
Phone (570) 798-3490

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
OC018225PAMDPediatric Occupational Therapist

NPI Registry JSON

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

{
    "created_epoch": "1639958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780444800000",
    "number": "1063172997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 PETERSON AVE",
            "city": "SOUTH PASADENA",
            "state": "CA",
            "postal_code": "910304032",
            "telephone_number": "570-798-3490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 PETERSON AVE",
            "city": "SOUTH PASADENA",
            "state": "CA",
            "postal_code": "910304032",
            "telephone_number": "570-798-3490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENSKE-VINCENT",
        "first_name": "KRISTINA",
        "middle_name": "LORRAINE",
        "credential": "OTR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-20",
        "last_updated": "2026-06-03",
        "certification_date": "2026-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "PA",
            "license": "OC018225",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Pasadena, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2026; 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.