Individual provider Active NPI

Vijaya Krishnamoorthy, OTR

  • Occupational Therapist
  • Saint Louis, MO
National Provider Identifier
1124260286
Registry record updated Apr 2, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
056005466 Issued in IL
Practice address
7733 Forsyth Blvd Ste 2300
Saint Louis, MO 63105-1806
Phone
(186) 631-4394
NPI assigned
Apr 2, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 056005466 IL Primary

Addresses

Primary practice location

7733 Forsyth Blvd Ste 2300
Saint Louis, MO 63105-1806

Mailing address

2800 Crestfield CT
Naperville, IL 60565-3043
Phone (630) 416-7939

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240701001087 IL Practitioner - Occupational Therapist in Private Practice 5294279303 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
056005466ILMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Paxxon Healthcare Services LLC Occupational Therapist CurrentSince May 31, 2024 Accepting new patients
Paxxon Healthcare Services LLC Occupational Therapist CurrentSince May 31, 2024 Accepting new patients

Locations

1619 N Mill St
Naperville, IL 60563
Phone (630) 701-6040

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1238630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1238630400000",
    "number": "1124260286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 CRESTFIELD CT",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605653043",
            "telephone_number": "630-416-7939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7733 FORSYTH BLVD STE 2300",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631051806",
            "telephone_number": "186-631-4394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRISHNAMOORTHY",
        "first_name": "VIJAYA",
        "credential": "OTR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-02",
        "last_updated": "2009-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056005466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2009; 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.

Verify at the official NPI Registry.