Active NPI
Kelly Marie Newcomb, COTA
- Occupational Therapist
- Palos Hills, IL
National Provider Identifier
1497221139
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 057004711
- Practice address
- 10400 S Roberts Rd
Palos Hills, IL 60465-1972 - Phone
- (708) 443-7400
- NPI assigned
- Oct 21, 2018
- Last updated
- Oct 21, 2018
- Sex
- Female
- Sole proprietor
- Yes
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 | 057004711 | IL | Primary |
Addresses
Primary practice location
10400 S Roberts Rd
Palos Hills, IL 60465-1972
Mailing address
11130 S Homan Ave
Chicago, IL 60655-3504
Phone (708) 925-7534
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 |
|---|---|---|---|
| 057004711 | IL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540080000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1540080000000",
"number": "1497221139",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11130 S HOMAN AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606553504",
"telephone_number": "708-925-7534"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10400 S ROBERTS RD",
"city": "PALOS HILLS",
"state": "IL",
"postal_code": "604651972",
"telephone_number": "708-443-7400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEWCOMB",
"first_name": "KELLY",
"middle_name": "MARIE",
"credential": "COTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-10-21",
"last_updated": "2018-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IL",
"license": "057004711",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palos Hills, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.