Kimberly Ann Searles, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

6824 Issued in AZ

Practice address

3401 Lockwood Dr
Lakeside, AZ 85929-5613

Phone

(602) 718-6750

NPI assigned

Apr 15, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Kimberly Ann Tysseling Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1492214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492214400000",
    "number": "1518491653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1962",
            "city": "LAKESIDE",
            "state": "AZ",
            "postal_code": "859291962",
            "telephone_number": "602-718-6750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 LOCKWOOD DR",
            "city": "LAKESIDE",
            "state": "AZ",
            "postal_code": "859295613",
            "telephone_number": "602-718-6750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEARLES",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "COTA/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-15",
        "last_updated": "2017-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "NM",
            "license": "2913",
            "primary": false
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "CA",
            "license": "3165",
            "primary": false
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "AZ",
            "license": "6824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "TYSSELING",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Occupational Therapy Assistant in Lakeside, AZ
• Providers in Lakeside, AZ by specialty
• Occupational Therapy Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 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.

Verify at the official NPI Registry.