Individual provider Active NPI

Kristin Marie Clewell, OTR L

  • Pediatric Occupational Therapist
  • Mooresville, NC
National Provider Identifier
1154387330
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
License
4394 Issued in NC
Practice address
137 Overhill Dr
Suite 102
Mooresville, NC 28117-8006
Phone
(704) 799-6824
Fax
(704) 799-6825
NPI assigned
Apr 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 4394 NC
Pediatric Occupational Therapist 225XP0200X 4394 NC Primary

Addresses

Primary practice location

137 Overhill Dr
Suite 102
Mooresville, NC 28117-8006

Mailing address

12700 Cypress Springs Rd
Huntersville, NC 28078-9146

Other identifiers 1

IdentifierTypeStateIssuer
7301459MedicaidNC

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

LicenseStateTypeSpecialty
4394NCMDPsychologist

NPI Registry JSON

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1154387330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12700 CYPRESS SPRINGS RD",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280789146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "137 OVERHILL DR",
            "address_2": "SUITE 102",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178006",
            "telephone_number": "704-799-6824",
            "fax_number": "704-799-6825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEWELL",
        "first_name": "KRISTIN",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "OTR  L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-25",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NC",
            "license": "4394",
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "NC",
            "license": "4394",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7301459",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mooresville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.