Active NPI
Kelly Souza, MSOT, OTR/L
- Occupational Therapist
- Seattle, WA
National Provider Identifier
1649731902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 60938017
- Practice address
- 10564 5TH Ave NE Ste 302
Seattle, WA 98125-7200 - Phone
- (909) 635-4814
- NPI assigned
- Mar 28, 2019
- 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 | 60938017 | WA | Primary |
Addresses
Primary practice location
10564 5TH Ave NE Ste 302
Seattle, WA 98125-7200
Mailing address
1620B N 46TH St
Seattle, WA 98103-6714
Phone (909) 635-4814
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190521002270 | WA | Practitioner - Occupational Therapist in Private Practice | 3870836570 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60938017 | WA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1553731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1553731200000",
"number": "1649731902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1620B N 46TH ST",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981036714",
"telephone_number": "909-635-4814"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10564 5TH AVE NE STE 302",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981257200",
"telephone_number": "909-635-4814"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUZA",
"first_name": "KELLY",
"credential": "MSOT, OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-03-28",
"last_updated": "2019-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WA",
"license": "60938017",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.