Active NPI
Kimberlie Ann Payne, COTA
- Occupational Therapy Assistant
- Waterford, CA
National Provider Identifier
1356686992
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- OC60114073
- Practice address
- 13209 Fountain Dr
Waterford, CA 95386-8858 - Phone
- (808) 937-3172
- NPI assigned
- Dec 8, 2012
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | OC60114073 | WA | Primary |
Addresses
Primary practice location
13209 Fountain Dr
Waterford, CA 95386-8858
Mailing address
13209 Fountain Dr
Waterford, CA 95386-8858
Phone (808) 937-3172
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 |
|---|---|---|---|
| OC60114073 | WA | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1354924800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1354924800000",
"number": "1356686992",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13209 FOUNTAIN DR",
"city": "WATERFORD",
"state": "CA",
"postal_code": "953868858",
"telephone_number": "808-937-3172"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13209 FOUNTAIN DR",
"city": "WATERFORD",
"state": "CA",
"postal_code": "953868858",
"telephone_number": "808-937-3172"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAYNE",
"first_name": "KIMBERLIE",
"middle_name": "ANN",
"credential": "COTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-12-08",
"last_updated": "2012-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "WA",
"license": "OC60114073",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waterford, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 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.