Active NPI
Katelyn Marie Mikels, PTA
- Physical Therapy Assistant
- Vestal, NY
National Provider Identifier
1720652373
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 006946-1
- Practice address
- 4102 Vestal Rd
Vestal, NY 13850-3553 - Phone
- (607) 772-1598
- NPI assigned
- May 18, 2021
- Last updated
- May 18, 2021
- 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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 006946-1 | NY | Primary |
Addresses
Primary practice location
4102 Vestal Rd
Vestal, NY 13850-3553
Mailing address
403 Dwight Ave
Endicott, NY 13760-4045
Phone (607) 768-5283
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 |
|---|---|---|---|
| 006946-1 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1621296000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621296000000",
"number": "1720652373",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "403 DWIGHT AVE",
"city": "ENDICOTT",
"state": "NY",
"postal_code": "137604045",
"telephone_number": "607-768-5283"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4102 VESTAL RD",
"city": "VESTAL",
"state": "NY",
"postal_code": "138503553",
"telephone_number": "607-772-1598"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIKELS",
"first_name": "KATELYN",
"middle_name": "MARIE",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-05-18",
"last_updated": "2021-05-18",
"certification_date": "2021-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NY",
"license": "006946-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vestal, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.