Active NPI
Kirstin Douglas, OTR/L
- Occupational Therapist
- Longwood, FL
National Provider Identifier
1104355528
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT18513
- Practice address
- 455 West Warren Ave
200
Longwood, FL 32750-4038 - Phone
- (407) 260-0551
- Fax
- (407) 265-9590
- NPI assigned
- Jun 8, 2017
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT18513 | FL | Primary |
Addresses
Primary practice location
455 West Warren Ave
200
Longwood, FL 32750-4038
Mailing address
455 W Warren Ave Ste 200
Longwood, FL 32750-4038
Phone (407) 260-0551
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OT18513 | Other | FL | STATE OF FLORIDA DEPT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE |
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 |
|---|---|---|---|
| OT18513 | FL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1496880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1104355528",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "455 W WARREN AVE STE 200",
"city": "LONGWOOD",
"state": "FL",
"postal_code": "327504038",
"telephone_number": "407-260-0551",
"fax_number": "407-265-9590"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "455 WEST WARREN AVE",
"address_2": "200",
"city": "LONGWOOD",
"state": "FL",
"postal_code": "327504038",
"telephone_number": "407-260-0551",
"fax_number": "407-265-9590"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGLAS",
"first_name": "KIRSTIN",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-06-08",
"last_updated": "2022-07-21",
"certification_date": "2021-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Occupational Therapist",
"state": "FL",
"license": "OT18513",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF FLORIDA DEPT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE",
"identifier": "OT18513",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Longwood, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.