NPIMap

Organization Active NPI

Kidsbridge Occupational Therapy

  • Specialist
  • Los Ranchos, NM
National Provider Identifier
1316283187
Registry record updated Dec 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
2414 Issued in NM
Legal business name
KIDSBRIDGE OCCUPATIONAL THERAPY
Practice address
1104 Salamanca St NW
Los Ranchos, NM 87107-5626
Phone
(505) 908-0717
Fax
(505) 344-5553
NPI assigned
Dec 22, 2012
Last updated
Dec 22, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
KIDSBRIDGE OCCUPATIONAL THERAPYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 22, 2012

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

Authorized official

Name
Mrs. Kristen S Wiese, MA OTR/LNPI 1841473527
Title
Owner/Operator
Phone
(505) 908-0717

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 2414 NM Primary

Addresses

Primary practice location

1104 Salamanca St NW
Los Ranchos, NM 87107-5626

Mailing address

1104 Salamanca St NW
Los Ranchos, NM 87107-5626
Phone (505) 908-0717

Other identifiers 1

IdentifierTypeStateIssuer
1841473527OtherNMNPI FOR INDIVIDUAL

National Provider Directory

National Provider Directory
Tax ID family
Kidsbridge2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1356134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1356134400000",
    "number": "1316283187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1104 SALAMANCA ST NW",
            "city": "LOS RANCHOS",
            "state": "NM",
            "postal_code": "871075626",
            "telephone_number": "505-908-0717",
            "fax_number": "505-344-5553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1104 SALAMANCA ST NW",
            "city": "LOS RANCHOS",
            "state": "NM",
            "postal_code": "871075626",
            "telephone_number": "505-908-0717",
            "fax_number": "505-344-5553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDSBRIDGE OCCUPATIONAL THERAPY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KIDSBRIDGE OCCUPATIONAL THERAPY",
        "enumeration_date": "2012-12-22",
        "last_updated": "2012-12-22",
        "status": "A",
        "authorized_official_last_name": "WIESE",
        "authorized_official_first_name": "KRISTEN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "505-908-0717",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MA OTR/L"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NM",
            "license": "2414",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI FOR INDIVIDUAL",
            "identifier": "1841473527",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Ranchos, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2012; 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.