Kristina Shupert, M.S., OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

0119006226 Issued in VA

Practice address

4560 South Blvd
Suite 310
Virginia Beach, VA 23452-1160

Phone

(757) 490-3223

Fax

(757) 490-2936

NPI assigned

Jun 18, 2014

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

Other identifiers 1

Other names 1

• Kristina Ethridge Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1403049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458864000000",
    "number": "1407260367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4560 SOUTH BLVD",
            "address_2": "SUITE 310",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234521160",
            "telephone_number": "757-490-3223",
            "fax_number": "757-490-2936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4560 SOUTH BLVD",
            "address_2": "SUITE 310",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234521160",
            "telephone_number": "757-490-3223",
            "fax_number": "757-490-2936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUPERT",
        "first_name": "KRISTINA",
        "credential": "M.S., OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-18",
        "last_updated": "2016-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "VA",
            "license": "0119006226",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSURE",
            "identifier": "0119006226",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTINA",
            "last_name": "ETHRIDGE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Stephanie Shuder, PHARMD
• Melinda M Shuler, MPT
• David Shulmister, MD
• Jason Thomas Shumadine, MD
• Eleanor T Shumaker, LCSW
• Kali Marie Shy
• Nicole Sibiga, CFO
• Karen Elizabeth Sickenger, MD
• Kathryn Sidrow
• Gary Richard Siegel, M.D.

• All providers in Virginia Beach, VA
• Occupational Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2016; 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.