Individual provider Active NPI

Maryann Von Kluegl, COTA

  • Occupational Therapy Assistant
  • Santee, CA
National Provider Identifier
1063283034
Registry record updated Jan 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
6560 Issued in CA
Practice address
10538 Mission Gorge Rd Ste 130
Santee, CA 92071-3154
Phone
(619) 312-6109
Fax
(619) 312-6110
NPI assigned
Jan 9, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2024

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 6560 CA Primary

Addresses

Primary practice location

10538 Mission Gorge Rd Ste 130
Santee, CA 92071-3154

Mailing address

9555 Cottonwood Ave Unit D
Santee, CA 92071-6705
Phone (619) 249-1597

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

NPI Registry JSON

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

{
    "created_epoch": "1704758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704758400000",
    "number": "1063283034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9555 COTTONWOOD AVE UNIT D",
            "city": "SANTEE",
            "state": "CA",
            "postal_code": "920716705",
            "telephone_number": "619-249-1597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10538 MISSION GORGE RD STE 130",
            "city": "SANTEE",
            "state": "CA",
            "postal_code": "920713154",
            "telephone_number": "619-312-6109",
            "fax_number": "619-312-6110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VON KLUEGL",
        "first_name": "MARYANN",
        "credential": "COTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-09",
        "last_updated": "2024-01-09",
        "certification_date": "2024-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "CA",
            "license": "6560",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santee, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2024; 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.