Active NPI
Hillary Dembroff, OTR
- Pediatric Occupational Therapist
- South Lake Tahoe, CA
National Provider Identifier
1568588762
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- OT 1040
- Practice address
- 1360 Johnson Blvd
Suite 103
South Lake Tahoe, CA 96150-8220 - Phone
- (530) 543-2313
- NPI assigned
- Mar 21, 2007
- 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 |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | OT 1040 | CA | Primary |
Addresses
Primary practice location
1360 Johnson Blvd
Suite 103
South Lake Tahoe, CA 96150-8220
Mailing address
PO Box 9484
South Lake Tahoe, CA 96158-2484
Phone (530) 543-2313
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 |
|---|---|---|---|
| OT 1040 | CA | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1568588762",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9484",
"city": "SOUTH LAKE TAHOE",
"state": "CA",
"postal_code": "961582484",
"telephone_number": "530-543-2313"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1360 JOHNSON BLVD",
"address_2": "SUITE 103",
"city": "SOUTH LAKE TAHOE",
"state": "CA",
"postal_code": "961508220",
"telephone_number": "530-543-2313"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEMBROFF",
"first_name": "HILLARY",
"credential": "OTR",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "CA",
"license": "OT 1040",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Lake Tahoe, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.