Modified Independence Evaluations Inc

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

Legal business name

MODIFIED INDEPENDENCE EVALUATIONS INC

Practice address

1280 Harbour Town Dr
Orange Park, FL 32065-2562

Phone

(904) 710-8571

NPI assigned

Apr 17, 2023

Organization subpart

No

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

Authorized official

Name

Kristopher Wilson, OTR/LNPI 1578739975

Title

Authorized Official

Phone

(904) 710-8571

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Practitioners 1

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.

• Kristopher Edward Wilson, MOT

  • Occupational Therapist
  • Orange Park, FL
  • NPI 1578739975
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1681689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681689600000",
    "number": "1356037980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1280 HARBOUR TOWN DR",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320652562",
            "telephone_number": "904-710-8571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1280 HARBOUR TOWN DR",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320652562",
            "telephone_number": "904-710-8571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODIFIED INDEPENDENCE EVALUATIONS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-17",
        "last_updated": "2023-04-17",
        "certification_date": "2023-04-16",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "KRISTOPHER",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "904-710-8571",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in Orange Park, FL
• Providers in Orange Park, FL by specialty
• Occupational Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2023; 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.