Active NPI
Kelly Todd Flemetakis, MOT
- Pediatric Occupational Therapist
- Woodinville, WA
National Provider Identifier
1639211725
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- OT00003368
- Practice address
- 16635 168TH PL NE
Suite 2
Woodinville, WA 98072-8988 - Phone
- (206) 683-4928
- Fax
- (425) 481-3332
- NPI assigned
- Feb 13, 2007
- Last updated
- Jul 16, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | OT00003368 | WA | Primary |
Addresses
Primary practice location
16635 168TH PL NE
Suite 2
Woodinville, WA 98072-8988
Mailing address
16635 168TH PL NE
Suite 2
Woodinville, WA 98072-8988
Phone (206) 683-4928
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0007633803 | Other | WA | AETNA PROVIDER NUMBER |
| 7683683 | Medicaid | WA | |
| 743167413 | Other | WA | TAX IDENTIFICATION NUMBER |
| 351452100000 | Other | WA | PREMERA PROVIDER NUMBER |
| 3153FL | Other | WA | REGENCE PROVIDER NUMBER |
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 |
|---|---|---|---|
| OT00003368 | WA | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405468800000",
"number": "1639211725",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16635 168TH PL NE",
"address_2": "SUITE 2",
"city": "WOODINVILLE",
"state": "WA",
"postal_code": "980728988",
"telephone_number": "206-683-4928",
"fax_number": "425-481-3332"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16635 168TH PL NE",
"address_2": "SUITE 2",
"city": "WOODINVILLE",
"state": "WA",
"postal_code": "980728988",
"telephone_number": "206-683-4928",
"fax_number": "425-481-3332"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FLEMETAKIS",
"first_name": "KELLY",
"middle_name": "TODD",
"credential": "MOT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-13",
"last_updated": "2014-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "WA",
"license": "OT00003368",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PROVIDER NUMBER",
"identifier": "0007633803",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7683683",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX IDENTIFICATION NUMBER",
"identifier": "743167413",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREMERA PROVIDER NUMBER",
"identifier": "351452100000",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE PROVIDER NUMBER",
"identifier": "3153FL",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Woodinville, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 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.