Kelly J Formanek, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

Practice address

4415 Rio D Oro
San Antonio, TX 78233-6748

Phone

(210) 651-3339

NPI assigned

Jul 23, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1153612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1326069352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 SULLIVAN TRL",
            "city": "EASTON",
            "state": "PA",
            "postal_code": "180407958",
            "telephone_number": "610-991-2034",
            "fax_number": "610-991-0205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4415 RIO D ORO",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782336748",
            "telephone_number": "210-651-3339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMANEK",
        "first_name": "KELLY",
        "middle_name": "J",
        "credential": "COTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Nicole Forgette, RBT
• James Glenn Forister, PA-C
• Conrad Thomas Forkheim, RBT
• Danielle Forland
• Caroline Kittrell Forman, CNP
• Rafael Jorge Fornaris, M.D.
• Darla Ann Forney, B.S., RKT
• Travis Forney, PA-C
• Peter S. Fornos, MD
• Sarah Ann Forren, MA, LPC

• Occupational Therapy Assistant in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Occupational Therapy Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.