Active NPI
Kelly Miller Wyrick
- Occupational Therapist
- Wytheville, VA
National Provider Identifier
1417549585
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 0119004189
- Practice address
- 800 E Main St
Wytheville, VA 24382-3300 - Phone
- (276) 228-6200
- NPI assigned
- Feb 9, 2021
- 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 Therapist | 225X00000X | 0119004189 | VA | Primary |
Addresses
Primary practice location
800 E Main St
Wytheville, VA 24382-3300
Mailing address
1137 Huckleberry Rd
Crockett, VA 24323-3101
Phone (276) 620-4623
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 |
|---|---|---|---|
| 0119004189 | VA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1612828800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1612828800000",
"number": "1417549585",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1137 HUCKLEBERRY RD",
"city": "CROCKETT",
"state": "VA",
"postal_code": "243233101",
"telephone_number": "276-620-4623"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 E MAIN ST",
"city": "WYTHEVILLE",
"state": "VA",
"postal_code": "243823300",
"telephone_number": "276-228-6200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYRICK",
"first_name": "KELLY",
"middle_name": "MILLER",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-02-09",
"last_updated": "2021-02-09",
"certification_date": "2021-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "VA",
"license": "0119004189",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wytheville, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.