Active NPI
Kim Koehler Russell, OTR/L
- Hand Occupational Therapist
- San Diego, CA
National Provider Identifier
1184866899
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hand Occupational Therapist
- License
- 9543
- Practice address
- 3666 Kearny Villa Rd
Suite 308
San Diego, CA 92123-1951 - Phone
- (858) 505-5460
- NPI assigned
- Mar 26, 2009
- 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 |
|---|---|---|---|---|
| Hand Occupational Therapist | 225XH1200X | 9543 | CA | Primary |
Addresses
Primary practice location
3666 Kearny Villa Rd
Suite 308
San Diego, CA 92123-1951
Mailing address
715 Colima Street
La Jolla, CA 92037
Phone (619) 894-9398
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
| License | State | Type | Specialty |
|---|---|---|---|
| 9543 | CA | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1238025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1238025600000",
"number": "1184866899",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "715 COLIMA STREET",
"city": "LA JOLLA",
"state": "CA",
"postal_code": "92037",
"telephone_number": "619-894-9398"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3666 KEARNY VILLA RD",
"address_2": "SUITE 308",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921231951",
"telephone_number": "858-505-5460"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "KIM",
"middle_name": "KOEHLER",
"name_prefix": "Mrs.",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-03-26",
"last_updated": "2009-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "225XH1200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Hand",
"state": "CA",
"license": "9543",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.