Active NPI
Kenneth James Florence, OTA
- Occupational Therapy Assistant
- Bloomington, IL
National Provider Identifier
1427929645
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 057-000930
- Practice address
- 2200 E Washington St
Bloomington, IL 61701-4364 - Phone
- (309) 661-6260
- Fax
- (309) 662-1628
- NPI assigned
- Sep 12, 2025
- Sex
- Male
- 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 Therapy Assistant | 224Z00000X | 057-000930 | IL | Primary |
Addresses
Primary practice location
2200 E Washington St
Bloomington, IL 61701-4364
Mailing address
2200 E Washington St
Bloomington, IL 61701-4364
Phone (309) 661-6260
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 |
|---|---|---|---|
| 057-000930 | IL | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1757635200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757635200000",
"number": "1427929645",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2200 E WASHINGTON ST",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617014364",
"telephone_number": "309-661-6260",
"fax_number": "309-662-1628"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2200 E WASHINGTON ST",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617014364",
"telephone_number": "309-661-6260",
"fax_number": "309-662-1628"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FLORENCE",
"first_name": "KENNETH",
"middle_name": "JAMES",
"name_prefix": "Mr.",
"credential": "OTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-09-12",
"last_updated": "2025-09-12",
"certification_date": "2025-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "IL",
"license": "057-000930",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 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.