Active NPI
Kim Takayo Elliott, CTRS
- Recreation Therapist
- San Diego, CA
National Provider Identifier
1083470736
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Recreation Therapist
- License
- 33042
- Practice address
- 3350 La Jolla Village Dr
San Diego, CA 92161-0002 - Phone
- (619) 920-1807
- NPI assigned
- Feb 21, 2024
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | 33042 | CA | Primary |
Addresses
Primary practice location
3350 La Jolla Village Dr
San Diego, CA 92161-0002
Mailing address
3350 La Jolla Village Dr
San Diego, CA 92161-0002
Phone (619) 920-1807
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 |
|---|---|---|---|
| 33042 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1708473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1708473600000",
"number": "1083470736",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3350 LA JOLLA VILLAGE DR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921610002",
"telephone_number": "619-920-1807"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3350 LA JOLLA VILLAGE DR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921610002",
"telephone_number": "619-920-1807"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIOTT",
"first_name": "KIM",
"middle_name": "TAKAYO",
"credential": "CTRS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-02-21",
"last_updated": "2024-02-21",
"certification_date": "2024-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "225800000X",
"taxonomy_group": "",
"desc": "Recreation Therapist",
"state": "CA",
"license": "33042",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 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.