Active NPI
Kristie Ann Dodge, OTR/L
- Occupational Therapist
- Prescott, AZ
National Provider Identifier
1376587428
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 2976
- Practice address
- 340 N Mount Vernon Ave
Prescott, AZ 86301-2620 - Phone
- (928) 771-0465
- NPI assigned
- Jun 16, 2006
- 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 Therapist | 225X00000X | 2976 | AZ | Primary |
Addresses
Primary practice location
340 N Mount Vernon Ave
Prescott, AZ 86301-2620
Mailing address
100 E Michigan Ave Ste 103
Jackson, MI 49201-1406
Phone (902) 308-4801
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2976 | AZ | MD | Prosthodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Merrill Enterprises, Inc | Occupational Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Occupational Therapist
- Prescott, AZ
- NPI 1063470318
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1740355200000",
"number": "1376587428",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 E MICHIGAN AVE STE 103",
"city": "JACKSON",
"state": "MI",
"postal_code": "492011406",
"telephone_number": "902-308-4801"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "340 N MOUNT VERNON AVE",
"city": "PRESCOTT",
"state": "AZ",
"postal_code": "863012620",
"telephone_number": "928-771-0465"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DODGE",
"first_name": "KRISTIE",
"middle_name": "ANN",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-16",
"last_updated": "2025-02-24",
"certification_date": "2025-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "AZ",
"license": "2976",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Prescott, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.