Active NPI
Kimberly Scanlon, MOT, OTR/L
- Pediatric Occupational Therapist
- Hollywood, FL
National Provider Identifier
1487110862
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- 19787
- Practice address
- 1 Oakwood Blvd Ste 130
Hollywood, FL 33020-1937 - Phone
- (954) 925-3844
- NPI assigned
- Feb 11, 2019
- 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 |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 19787 | FL | Primary |
Addresses
Primary practice location
1 Oakwood Blvd Ste 130
Hollywood, FL 33020-1937
Mailing address
2301 SW 85TH Way
Davie, FL 33324-5360
Phone (501) 388-3528
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 889063300 | Medicaid | FL |
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 |
|---|---|---|---|
| 19787 | FL | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1549843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550275200000",
"number": "1487110862",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2301 SW 85TH WAY",
"city": "DAVIE",
"state": "FL",
"postal_code": "333245360",
"telephone_number": "501-388-3528"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 OAKWOOD BLVD STE 130",
"city": "HOLLYWOOD",
"state": "FL",
"postal_code": "330201937",
"telephone_number": "954-925-3844"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCANLON",
"first_name": "KIMBERLY",
"credential": "MOT, OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-02-11",
"last_updated": "2019-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "FL",
"license": "19787",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "889063300",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hollywood, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 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.