Active NPI
Kersti Pettit-Kekel, OT
- Occupational Therapist
- Portland, OR
National Provider Identifier
1184639684
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 970486
- Practice address
- 707 SW Gaines St
Portland, OR 97239-2901 - Phone
- (800) 452-3563
- NPI assigned
- Jul 31, 2006
- 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 | 970486 | OR | Primary |
Addresses
Primary practice location
707 SW Gaines St
Portland, OR 97239-2901
Mailing address
707 SW Gaines St
Portland, OR 97239-2901
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 295700 | Medicaid | OR |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 970486 | OR | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588204800000",
"number": "1184639684",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "707 SW GAINES ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972392901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "707 SW GAINES ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972392901",
"telephone_number": "800-452-3563"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTIT-KEKEL",
"first_name": "KERSTI",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-31",
"last_updated": "2020-04-30",
"certification_date": "2020-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "OR",
"license": "970486",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "295700",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.