Active NPI
Kristi Ann Derycke
- Occupational Therapist
- Cedar Rapids, IA
National Provider Identifier
1104678226
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 01018
- Practice address
- 3245 Williams Pkwy SW
Cedar Rapids, IA 52404-1446 - Phone
- (319) 369-8820
- Fax
- (319) 368-5866
- NPI assigned
- Apr 2, 2024
- 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 | 01018 | IA | Primary |
Addresses
Primary practice location
3245 Williams Pkwy SW
Cedar Rapids, IA 52404-1446
Mailing address
7834 11TH Avenue TRL
Belle Plaine, IA 52208-8830
Phone (319) 573-5268
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 |
|---|---|---|---|
| 01018 | IA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1712016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712016000000",
"number": "1104678226",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7834 11TH AVENUE TRL",
"city": "BELLE PLAINE",
"state": "IA",
"postal_code": "522088830",
"telephone_number": "319-573-5268"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3245 WILLIAMS PKWY SW",
"city": "CEDAR RAPIDS",
"state": "IA",
"postal_code": "524041446",
"telephone_number": "319-369-8820",
"fax_number": "319-368-5866"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERYCKE",
"first_name": "KRISTI",
"middle_name": "ANN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-04-02",
"last_updated": "2024-04-02",
"certification_date": "2024-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IA",
"license": "01018",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cedar Rapids, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 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.