Active NPI
Kristian Carlos Llaca, OTD,OTR/L, ATP,CSRS
- Neurorehabilitation Occupational Therapist
- Pembroke Pines, FL
National Provider Identifier
1265021992
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurorehabilitation Occupational Therapist
- License
- OT16273
- Practice address
- 1239 NW 166TH Ave
Pembroke Pines, FL 33028-1345 - Phone
- (305) 431-0887
- NPI assigned
- Jan 17, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assistive Technology Practitioner Rehabilitation Counselor | 225CA2400X | OT16273 | FL | |
| Environmental Modification Occupational Therapist | 225XE0001X | OT16273 | FL | |
| Ergonomics Occupational Therapist | 225XE1200X | OT16273 | FL | |
| Physical Rehabilitation Occupational Therapist | 225XP0019X | OT16273 | FL | |
| Neurorehabilitation Occupational Therapist | 225XN1300X | OT16273 | FL | Primary |
Addresses
Primary practice location
1239 NW 166TH Ave
Pembroke Pines, FL 33028-1345
Mailing address
1239 NW 166TH Ave
Pembroke Pines, FL 33028-1345
Phone (305) 431-0887
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 |
|---|---|---|---|
| OT16273 | FL | MD | Physical Rehabilitation Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610841600000",
"number": "1265021992",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1239 NW 166TH AVE",
"city": "PEMBROKE PINES",
"state": "FL",
"postal_code": "330281345",
"telephone_number": "305-431-0887"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1239 NW 166TH AVE",
"city": "PEMBROKE PINES",
"state": "FL",
"postal_code": "330281345",
"telephone_number": "305-431-0887"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LLACA",
"first_name": "KRISTIAN",
"middle_name": "CARLOS",
"name_prefix": "Dr.",
"credential": "OTD,OTR/L, ATP,CSRS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-01-17",
"last_updated": "2021-01-17",
"certification_date": "2021-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "225CA2400X",
"taxonomy_group": "",
"desc": "Rehabilitation Counselor, Assistive Technology Practitioner",
"state": "FL",
"license": "OT16273",
"primary": false
},
{
"code": "225XE0001X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Environmental Modification",
"state": "FL",
"license": "OT16273",
"primary": false
},
{
"code": "225XE1200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Ergonomics",
"state": "FL",
"license": "OT16273",
"primary": false
},
{
"code": "225XP0019X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Physical Rehabilitation",
"state": "FL",
"license": "OT16273",
"primary": false
},
{
"code": "225XN1300X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Neurorehabilitation",
"state": "FL",
"license": "OT16273",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pembroke Pines, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.