Active NPI
Kylie Long, COTA
- Occupational Therapy Assistant
- Quincy, IL
National Provider Identifier
1346578226
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 057002428
- Practice address
- 804 State St
#5
Quincy, IL 62301-4951 - Phone
- (217) 224-1750
- Fax
- (217) 224-0403
- NPI assigned
- Dec 3, 2009
- Last updated
- Dec 3, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 057002428 | IL | Primary |
Addresses
Primary practice location
804 State St
#5
Quincy, IL 62301-4951
Mailing address
804 State St
#5
Quincy, IL 62301-4951
Phone (217) 224-1750
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 |
|---|---|---|---|
| 057002428 | IL | MD | Occupational Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Athletic and Therapeutic Institute of Bourbonnais, LLC | Past | Accepting new patients | |
| Athletic and Therapeutic Institute of Bourbonnais, LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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-
dba ATI Physical Therapy
- Physical Therapist
- Bourbonnais, IL
- NPI 1861503542
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1259798400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1259798400000",
"number": "1346578226",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "804 STATE ST",
"address_2": "#5",
"city": "QUINCY",
"state": "IL",
"postal_code": "623014951",
"telephone_number": "217-224-1750",
"fax_number": "217-224-0403"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "804 STATE ST",
"address_2": "#5",
"city": "QUINCY",
"state": "IL",
"postal_code": "623014951",
"telephone_number": "217-224-1750",
"fax_number": "217-224-0403"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONG",
"first_name": "KYLIE",
"credential": "COTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-12-03",
"last_updated": "2009-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "IL",
"license": "057002428",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Quincy, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.