Active NPI
Kristin Wallock
- Occupational Therapist
- Webster Groves, MO
National Provider Identifier
1629012760
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 104627
- Practice address
- 45 E Lockwood Ave
Webster Groves, MO 63119-3050 - Phone
- (314) 918-7300
- NPI assigned
- Jun 16, 2006
- Last updated
- May 26, 2014
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 4024 | WI | |
| Occupational Therapist | 225X00000X | 2011035655 | MO | |
| Occupational Therapist | 225X00000X | 104627 | MN | Primary |
Addresses
Primary practice location
45 E Lockwood Ave
Webster Groves, MO 63119-3050
Mailing address
705 Kingfisher LN Apt I
Woodbury, MN 55125-1850
Phone (414) 350-7070
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 |
|---|---|---|---|
| 104627 | MN | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1401062400000",
"number": "1629012760",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "705 KINGFISHER LN APT I",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551251850",
"telephone_number": "414-350-7070"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "45 E LOCKWOOD AVE",
"city": "WEBSTER GROVES",
"state": "MO",
"postal_code": "631193050",
"telephone_number": "314-918-7300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLOCK",
"first_name": "KRISTIN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-16",
"last_updated": "2014-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WI",
"license": "4024",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MO",
"license": "2011035655",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MN",
"license": "104627",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Webster Groves, MO
- Julie Molitor Vachalek, M.S., CCC-SLP
- Roland Scott Van Nest, P.T.
- Vincent U Rapini DDS PC (Old Orchard Dental Care)
- Tina Vora, PLPC
- Walgreen Co (Walgreens #07680)
- Jamese A'Rea Walton, PLPC
- Marian Patricia Wandall, PLPC
- Webster Ambulatory Surgery Center LP (Webster Surgery Center)
- Webster Dental Care
- Kurt A Weisenfels, D.D.S.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.