Active NPI
Kimberly Lane Winfree
- Occupational Therapist
- Palm Bay, FL
National Provider Identifier
1629387311
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT10919
- Practice address
- 678 Narragansett St NE
Palm Bay, FL 32907 - Phone
- (321) 634-2196
- NPI assigned
- Sep 29, 2010
- Last updated
- Aug 3, 2023
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT10919 | FL | Primary |
| Pediatric Occupational Therapist | 225XP0200X | NU |
Addresses
Primary practice location
678 Narragansett St NE
Palm Bay, FL 32907
Mailing address
814 N Main St
Kissimmee, FL 34744-5433
Phone (407) 931-1014
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 891141000 | Medicaid | FL |
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 |
|---|---|---|---|
| OT10919 | FL | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kids First Day Care Inc | Current | Accepting new patients | |
| Kids First Therapy Center Inc | Occupational Therapist | Current | Accepting new patients |
| Victory Ridge Academy, Inc. | Occupational Therapist | Past | Accepting new patients |
Locations
814 N Main St
Kissimmee, FL 34744
Phone (407) 931-1014
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
- Kissimmee, FL
- NPI 1124815923
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691020800000",
"number": "1629387311",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "814 N MAIN ST",
"city": "KISSIMMEE",
"state": "FL",
"postal_code": "347445433",
"telephone_number": "407-931-1014",
"fax_number": "407-933-1224"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "678 NARRAGANSETT ST NE",
"city": "PALM BAY",
"state": "FL",
"postal_code": "32907",
"telephone_number": "321-634-2196"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WINFREE",
"first_name": "KIMBERLY",
"middle_name": "LANE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-09-29",
"last_updated": "2023-08-03",
"certification_date": "2023-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "OT10919",
"primary": true
},
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "891141000",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Palm Bay, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 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.