Active NPI
Phillip King, OTR/L
- Occupational Therapist
- Salem, WV
National Provider Identifier
1063972099
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 2022
- Practice address
- 225 Sunbridge Dr.
Salem, WV 26426 - Phone
- (304) 782-3000
- NPI assigned
- Mar 25, 2019
- Sex
- Male
- 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 Therapist | 225X00000X | 2022 | WV | Primary |
Addresses
Primary practice location
225 Sunbridge Dr.
Salem, WV 26426
Mailing address
1121 Queens CT
Morgantown, WV 26508-9161
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230807002248 | WV | Practitioner - Occupational Therapist in Private Practice | 6608237631 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2022 | WV | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Powerback Rehabilitation LLC | Occupational Therapist | Current | Accepting new patients |
| Powerback Rehabilitation LLC | Occupational Therapist | Current | Accepting new patients |
Locations
101 E State St
Kennett Square, PA 19348
Phone (610) 925-4436
Organizations & group practices 2
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.
-
- Physical Therapist
- Woodbridge, VA
- NPI 1790640761
Occupational Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1553472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1553472000000",
"number": "1063972099",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1121 QUEENS CT",
"city": "MORGANTOWN",
"state": "WV",
"postal_code": "265089161"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "225 SUNBRIDGE DR.",
"city": "SALEM",
"state": "WV",
"postal_code": "26426",
"telephone_number": "304-782-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KING",
"first_name": "PHILLIP",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-03-25",
"last_updated": "2019-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WV",
"license": "2022",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.