Active NPI
Kristin Marie Wallace, OTR/L
- Human Factors Occupational Therapist
- Arlington, VA
National Provider Identifier
1437455219
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Human Factors Occupational Therapist
- License
- 2758
- Practice address
- 2110 Washington Blvd Ste. 158
Arlington, VA 22204 - Phone
- (202) 427-8290
- NPI assigned
- Jan 27, 2011
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Human Factors Occupational Therapist | 225XH1300X | 0119004399 | VA | |
| Human Factors Occupational Therapist | 225XH1300X | 010000508 | DC | |
| Human Factors Occupational Therapist | 225XH1300X | 220439 | OR | |
| Human Factors Occupational Therapist | 225XH1300X | 2758 | NM | Primary |
Addresses
Primary practice location
2110 Washington Blvd Ste. 158
Arlington, VA 22204
Mailing address
2110 Washington Blvd Ste. 158
Arlington, VA 22204
Phone (202) 427-8290
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 |
|---|---|---|---|
| 010000508 | DC | MD | Human Factors Occupational Therapist |
| 2758 | NM | MD | Human Factors Occupational Therapist |
| 220439 | OR | MD | Human Factors Occupational Therapist |
| 0119004399 | VA | MD | Human Factors Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1296086400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548806400000",
"number": "1437455219",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2110 WASHINGTON BLVD STE. 158",
"city": "ARLINGTON",
"state": "VA",
"postal_code": "22204",
"telephone_number": "202-427-8290"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2110 WASHINGTON BLVD STE. 158",
"city": "ARLINGTON",
"state": "VA",
"postal_code": "22204",
"telephone_number": "202-427-8290"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "KRISTIN",
"middle_name": "MARIE",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-01-27",
"last_updated": "2019-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "225XH1300X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Human Factors",
"state": "VA",
"license": "0119004399",
"primary": false
},
{
"code": "225XH1300X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Human Factors",
"state": "DC",
"license": "010000508",
"primary": false
},
{
"code": "225XH1300X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Human Factors",
"state": "OR",
"license": "220439",
"primary": false
},
{
"code": "225XH1300X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Human Factors",
"state": "NM",
"license": "2758",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Arlington, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.