Active NPI
Teresa Klokkenga
- Occupational Therapy Assistant
- Colorado Springs, CO
National Provider Identifier
1063695153
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- AA563015
- Practice address
- 8540 Scarborough Dr
Colorado Springs, CO 80920-7502 - Phone
- (719) 597-0822
- Fax
- (719) 599-4606
- NPI assigned
- Dec 11, 2007
- Sex
- Female
- Sole proprietor
- No
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 Therapy Assistant | 224Z00000X | AA563015 | IL | Primary |
Addresses
Primary practice location
8540 Scarborough Dr
Colorado Springs, CO 80920-7502
Mailing address
8540 Scarborough Dr
Colorado Springs, CO 80920-7502
Phone (719) 597-0822
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 |
|---|---|---|---|
| AA563015 | IL | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1197331200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1197331200000",
"number": "1063695153",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8540 SCARBOROUGH DR",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809207502",
"telephone_number": "719-597-0822",
"fax_number": "719-599-4606"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8540 SCARBOROUGH DR",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809207502",
"telephone_number": "719-597-0822",
"fax_number": "719-599-4606"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLOKKENGA",
"first_name": "TERESA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-12-11",
"last_updated": "2007-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "IL",
"license": "AA563015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 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.