Active NPI
Kristin Danielle Mitzenmacher, OTR/L, MS
- Pediatric Occupational Therapist
- San Diego, CA
National Provider Identifier
1669006649
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- 20957
- Practice address
- 2909A Carleton St
San Diego, CA 92106-2713 - Phone
- (619) 795-7790
- NPI assigned
- Feb 27, 2020
- 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 |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 20957 | CA | Primary |
Addresses
Primary practice location
2909A Carleton St
San Diego, CA 92106-2713
Mailing address
5175 Andrew Jackson St
Oceanside, CA 92057-4404
Phone (909) 260-4931
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20957 | CA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1582761600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1582761600000",
"number": "1669006649",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5175 ANDREW JACKSON ST",
"city": "OCEANSIDE",
"state": "CA",
"postal_code": "920574404",
"telephone_number": "909-260-4931"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2909A CARLETON ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921062713",
"telephone_number": "619-795-7790"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITZENMACHER",
"first_name": "KRISTIN",
"middle_name": "DANIELLE",
"name_prefix": "Mrs.",
"credential": "OTR/L, MS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-02-27",
"last_updated": "2020-02-27",
"certification_date": "2020-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "CA",
"license": "20957",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.