Active NPI
Kristin Wollenzin
- Occupational Therapist
- Fleming Island, FL
National Provider Identifier
1306383914
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OTA2799
- Practice address
- 1958 Cedar River CT
Fleming Island, FL 32003-7939 - Phone
- (904) 304-2284
- NPI assigned
- Jan 22, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OTA2799 | TN | Primary |
| Occupational Therapist | 225X00000X | OTA12556 | FL |
Addresses
Primary practice location
1958 Cedar River CT
Fleming Island, FL 32003-7939
Mailing address
1958 Cedar River CT
Fleming Island, FL 32003-7939
Phone (904) 304-2284
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 |
|---|---|---|---|
| OTA12556 | FL | MD | Occupational Therapist |
| OTA2799 | TN | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1485043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1485043200000",
"number": "1306383914",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1958 CEDAR RIVER CT",
"city": "FLEMING ISLAND",
"state": "FL",
"postal_code": "320037939",
"telephone_number": "904-304-2284"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1958 CEDAR RIVER CT",
"city": "FLEMING ISLAND",
"state": "FL",
"postal_code": "320037939",
"telephone_number": "904-304-2284"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLLENZIN",
"first_name": "KRISTIN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-01-22",
"last_updated": "2017-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TN",
"license": "OTA2799",
"primary": true
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "OTA12556",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fleming Island, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 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.