Individual provider Active NPI

Kimberly Moutgalias, CTRS

  • Recreation Therapist
  • Lake City, FL
National Provider Identifier
1174498331
Registry record updated Oct 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Recreation TherapistTaxonomy code 225800000X
Practice address
619 S Marion Ave
Lake City, FL 32025-5808
Phone
(386) 755-3016
NPI assigned
Oct 8, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Recreation Therapist 225800000X Primary

Addresses

Primary practice location

619 S Marion Ave
Lake City, FL 32025-5808

Mailing address

9100 Buck Starling Rd Apt 75
Macclenny, FL 32063-4691
Phone (386) 755-3016

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

NPI Registry JSON

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

{
    "created_epoch": "1759881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759881600000",
    "number": "1174498331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9100 BUCK STARLING RD APT 75",
            "city": "MACCLENNY",
            "state": "FL",
            "postal_code": "320634691",
            "telephone_number": "386-755-3016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 S MARION AVE",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320255808",
            "telephone_number": "386-755-3016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOUTGALIAS",
        "first_name": "KIMBERLY",
        "credential": "CTRS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-10-08",
        "last_updated": "2025-10-08",
        "certification_date": "2025-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225800000X",
            "taxonomy_group": "",
            "desc": "Recreation Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 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.