Active NPI
Kellie M Wing, OTD, MS, OTR/L, CHT
- Occupational Therapist
- Winter Garden, FL
National Provider Identifier
1629581350
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT10964
- Practice address
- 2200 Fowler Grove Blvd
Winter Garden, FL 34787-5597 - Phone
- (407) 614-0533
- NPI assigned
- Nov 16, 2017
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT10964 | FL | Primary |
Addresses
Primary practice location
2200 Fowler Grove Blvd
Winter Garden, FL 34787-5597
Mailing address
11220 Cedar Grove CT
Windermere, FL 34786-3415
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
- Credentials
- Master of Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1510790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1708041600000",
"number": "1629581350",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11220 CEDAR GROVE CT",
"city": "WINDERMERE",
"state": "FL",
"postal_code": "347863415"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2200 FOWLER GROVE BLVD",
"city": "WINTER GARDEN",
"state": "FL",
"postal_code": "347875597",
"telephone_number": "407-614-0533"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WING",
"first_name": "KELLIE",
"middle_name": "M",
"credential": "OTD, MS, OTR/L, CHT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-11-16",
"last_updated": "2024-02-16",
"certification_date": "2024-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "OT10964",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winter Garden, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.