Individual provider Active NPI

Taylor Lee Kroll

  • Occupational Therapist
  • Coeur d'Alene, ID
National Provider Identifier
1154167443
Registry record updated Mar 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Practice address
1812 N Lakewood Dr Ste 100
Coeur D Alene, ID 83814-2635
Phone
(208) 966-4476
Fax
(208) 966-4475
NPI assigned
Jul 5, 2024
Last updated
Mar 11, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2025

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 NU Primary

Addresses

Primary practice location

1812 N Lakewood Dr Ste 100
Coeur D Alene, ID 83814-2635

Mailing address

1107 N 12TH St
Coeur D Alene, ID 83814-4457

Other practice location 1

1107 N 12th St
Coeur D Alene, ID 83814-4457
Phone (509) 713-5845

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240722002784 ID Practitioner - Occupational Therapist in Private Practice 7719423110 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthopedic Surgery and SportsGroup PAC ID 3375519168, 28 clinicians

Practice addresses (Care Compare)

1812 N Lakewood Dr
Suite 100
Coeur D Alene, ID 83814-2635
Phone (208) 966-4476

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopedic Surgery and Sports CurrentSince Jul 9, 2024 Accepting new patients
Orthopedic Surgery and Sports CurrentSince Jul 9, 2024 Accepting new patients

Locations

1812 N Lakewood Dr
Ste 100
Coeur D Alene, ID 83814
Phone (208) 770-2971

850 W Ironwood Dr
Ste 202
Coeur D Alene, ID 83814
Phone (208) 601-6038

1160 E Polston Ave
#B
Post Falls, ID 83854
Phone (208) 262-0156

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1720137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741651200000",
    "number": "1154167443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1107 N 12TH ST",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838144457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1812 N LAKEWOOD DR STE 100",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142635",
            "telephone_number": "208-966-4476",
            "fax_number": "208-966-4475"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1107 N 12th St",
            "address_purpose": "LOCATION",
            "city": "Coeur D Alene",
            "state": "ID",
            "postal_code": "838144457",
            "country_code": "US",
            "telephone_number": "509-713-5845",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KROLL",
        "first_name": "TAYLOR",
        "middle_name": "LEE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-05",
        "last_updated": "2025-03-11",
        "certification_date": "2025-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coeur d'Alene, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.