Active NPI
Kimberly M Fonder, OTR/L
- Occupational Therapist
- Burlington, NC
National Provider Identifier
1477560704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 6009
- Practice address
- 1225 Huffman Mill Rd
Suite 201
Burlington, NC 27215-8788 - Phone
- (336) 584-7689
- Fax
- (336) 584-8063
- NPI assigned
- Aug 1, 2006
- 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 | 6009 | NC | Primary |
Addresses
Primary practice location
1225 Huffman Mill Rd
Suite 201
Burlington, NC 27215-8788
Mailing address
2307 Mill LN
High Point, NC 27265-9184
Phone (336) 269-1034
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477560704 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Occupational Therapist in Private Practice
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2701 Pickett Rd
Durham, NC 27705-5688
Phone (919) 419-9600
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6009 | NC | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Legacy Healthcare Services, Inc. | Occupational Therapist | Current | Accepting new patients |
| Legacy Healthcare Services Inc | Occupational Therapist | Current | Accepting new patients |
Locations
2701 Pickett Rd
Durham, NC 27705
Phone (919) 419-4012
110 Horizon Dr
Ste 310
Raleigh, NC 27615
Phone (970) 215-3300
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Durham, NC
- NPI 1104823400
Occupational Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1431561600000",
"number": "1477560704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2307 MILL LN",
"city": "HIGH POINT",
"state": "NC",
"postal_code": "272659184",
"telephone_number": "336-269-1034"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1225 HUFFMAN MILL RD",
"address_2": "SUITE 201",
"city": "BURLINGTON",
"state": "NC",
"postal_code": "272158788",
"telephone_number": "336-584-7689",
"fax_number": "336-584-8063"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONDER",
"first_name": "KIMBERLY",
"middle_name": "M",
"name_prefix": "Mrs.",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-01",
"last_updated": "2015-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NC",
"license": "6009",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1477560704",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Burlington, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.