Individual provider Active NPI

Kristina Perez, OTR/L

  • Occupational Therapist
  • Bradenton, FL
National Provider Identifier
1275993099
Registry record updated Jan 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OT17579 Issued in FL
Practice address
872 62ND Street Cir E Ste 102
Bradenton, FL 34208-6238
Phone
(941) 251-6825
Fax
(941) 201-1626
NPI assigned
Mar 7, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 18, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X OT17579 FL Primary

Addresses

Primary practice location

872 62ND Street Cir E Ste 102
Bradenton, FL 34208-6238

Mailing address

872 62ND Street Cir E Ste 102
Bradenton, FL 34208-6238
Phone (941) 251-6825

Other identifiers 1

IdentifierTypeStateIssuer
016859300MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180216000256 FL Practitioner - Occupational Therapist in Private Practice 4082974837 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Speech Therapy and Education Professionals, LLC Occupational Therapist CurrentSince Jan 15, 2018 Accepting new patients

Locations

872 62nd Street Cir E
Ste 102
Bradenton, FL 34208
Phone (941) 251-6825

872 62nd Street Cir E
Ste 103
Bradenton, FL 34208
Phone (941) 251-6825

872 62nd Street Cir E
Bradenton, FL 34208
Phone (941) 251-6825

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1457308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516233600000",
    "number": "1275993099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "872 62ND STREET CIR E STE 102",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342086238",
            "telephone_number": "941-251-6825",
            "fax_number": "941-201-1626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "872 62ND STREET CIR E STE 102",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342086238",
            "telephone_number": "941-251-6825",
            "fax_number": "941-201-1626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEREZ",
        "first_name": "KRISTINA",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-03-07",
        "last_updated": "2018-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "FL",
            "license": "OT17579",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016859300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bradenton, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.