Active NPI
Regina Shawn Kenyon Carlson, COTA
- Occupational Therapy Assistant
- Mayer, AZ
National Provider Identifier
1629297072
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 3200
- Practice address
- 15452 Cholla Cir
Mayer, AZ 86333 - Phone
- (928) 443-7673
- NPI assigned
- Apr 24, 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 |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 3200 | AZ | Primary |
Addresses
Primary practice location
15452 Cholla Cir
Mayer, AZ 86333
Mailing address
12609 W Cercado LN
Litchfield Park, AZ 85340-5509
Phone (602) 391-6911
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 |
|---|---|---|---|
| 3200 | AZ | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548979200000",
"number": "1629297072",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12609 W CERCADO LN",
"city": "LITCHFIELD PARK",
"state": "AZ",
"postal_code": "853405509",
"telephone_number": "602-391-6911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15452 CHOLLA CIR",
"city": "MAYER",
"state": "AZ",
"postal_code": "86333",
"telephone_number": "928-443-7673"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENYON CARLSON",
"first_name": "REGINA",
"middle_name": "SHAWN",
"name_prefix": "Mrs.",
"credential": "COTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-24",
"last_updated": "2019-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "AZ",
"license": "3200",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mayer, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.