Individual provider Active NPI

Kristi Etchechury, COTA/L

  • Occupational Therapy Assistant
  • Phoenix, AZ
National Provider Identifier
1215455498
Registry record updated Sep 7, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
6721 Issued in AZ
Practice address
807 East Beck Lane
Phoenix, AZ 85022
Phone
(602) 369-4618
NPI assigned
Sep 7, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 7, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 6721 AZ Primary

Addresses

Primary practice location

807 East Beck Lane
Phoenix, AZ 85022

Mailing address

807 E Beck LN
Phoenix, AZ 85022-3503
Phone (602) 369-4618

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": "1504742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1504742400000",
    "number": "1215455498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "807 E BECK LN",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850223503",
            "telephone_number": "602-369-4618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "807 EAST BECK LANE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85022",
            "telephone_number": "602-369-4618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETCHECHURY",
        "first_name": "KRISTI",
        "credential": "COTA/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-09-07",
        "last_updated": "2017-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "AZ",
            "license": "6721",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2017; 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.