Active NPI
Kimberly Anne Mattox, OTR/L
- Occupational Therapist
- Jersey Shore, PA
National Provider Identifier
1104079045
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OC005616L
- Practice address
- 1008 Thompson St
Jersey Shore, PA 17740-1729 - Phone
- (570) 398-4747
- NPI assigned
- Oct 23, 2008
- 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 Therapist | 225X00000X | OC005616L | PA | Primary |
Addresses
Primary practice location
1008 Thompson St
Jersey Shore, PA 17740-1729
Mailing address
225 Delaware Dr
Watsontown, PA 17777-9715
Phone (570) 220-9082
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 |
|---|---|---|---|
| OC005616L | PA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1224720000000",
"number": "1104079045",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "225 DELAWARE DR",
"city": "WATSONTOWN",
"state": "PA",
"postal_code": "177779715",
"telephone_number": "570-220-9082"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1008 THOMPSON ST",
"city": "JERSEY SHORE",
"state": "PA",
"postal_code": "177401729",
"telephone_number": "570-398-4747"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTOX",
"first_name": "KIMBERLY",
"middle_name": "ANNE",
"name_prefix": "Ms.",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-23",
"last_updated": "2008-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "PA",
"license": "OC005616L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jersey Shore, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.