Active NPI
Jill Marie Kluczynski, OTR/L
- Occupational Therapist
- Waxhaw, NC
National Provider Identifier
1447765045
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 8107
- Practice address
- 700 Howie Mine Rd
Waxhaw, NC 28173-9715 - Phone
- (704) 243-7640
- NPI assigned
- Dec 5, 2017
- 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 | 8107 | NC | Primary |
Addresses
Primary practice location
700 Howie Mine Rd
Waxhaw, NC 28173-9715
Mailing address
8422 Dianthus CT Unit 104
Charlotte, NC 28277-4099
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 |
|---|---|---|---|
| 8107 | NC | MD | General Practice Dentistry |
| 5911 | SC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1512432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1512432000000",
"number": "1447765045",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8422 DIANTHUS CT UNIT 104",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282774099"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 HOWIE MINE RD",
"city": "WAXHAW",
"state": "NC",
"postal_code": "281739715",
"telephone_number": "704-243-7640"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLUCZYNSKI",
"first_name": "JILL",
"middle_name": "MARIE",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-12-05",
"last_updated": "2017-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NC",
"license": "8107",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waxhaw, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.