Jennifer Kertyzak, MS, OTR/L

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

9067 Issued in MA

Practice address

178 Norwood Ave
Cranston, RI 02905-3923

Phone

(401) 921-1470

NPI assigned

Jan 14, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1200268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689120000000",
    "number": "1588840086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "178 NORWOOD AVE",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029053923",
            "telephone_number": "401-474-2486",
            "fax_number": "617-383-6520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "178 NORWOOD AVE",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029053923",
            "telephone_number": "401-921-1470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERTYZAK",
        "first_name": "JENNIFER",
        "credential": "MS, OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-14",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "RI",
            "license": null,
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "MA",
            "license": "9067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mary Beth Kilinski, PSY.D.
• Kelly Kilmartin, MASTERS
• Jennifer Kilroy, LMHC
• Brianna Katherine Kimball, PHARMD
• Maxwell King, PTA

• Pediatric Occupational Therapist in Cranston, RI
• Providers in Cranston, RI by specialty
• Pediatric Occupational Therapist in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; 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.