Kristy May Clark – Pediatric Occupational Therapist

Key facts

NPI: 1730259342
Entity type: Individual (NPI type 1)
Primary specialty: Pediatric Occupational Therapist 225XP0200X
License: 1582 (NH)
Practice address: 144 Canal Street
Nashua, NH 03064
Phone: (603) 882-6333
Fax: (603) 889-5460
NPI assigned: Nov 9, 2006
Sex: Female
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Pediatric Occupational Therapist	225XP0200X	1582	NH	Yes

Addresses

Primary practice location

144 Canal Street
Nashua, NH 03064

Mailing address

144 Canal Street
Nashua, NH 03064
Phone (603) 882-6333

Other identifiers

Identifier	Type	State	Issuer
13Y003886NH01	Other	NH	BCBS
272746	Other	NH	CIGNA
561822	Other	NH	AETNA
626514	Other	NH	HARVARD PILGRIM
761242	Other	NH	TUFTS
99560056	Medicaid	NH

Other names

Mrs. Kristy May Dejnak Former name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1730259342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "144 CANAL STREET",
            "city": "NASHUA",
            "state": "NH",
            "postal_code": "03064",
            "telephone_number": "603-882-6333",
            "fax_number": "603-889-5460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "144 CANAL STREET",
            "city": "NASHUA",
            "state": "NH",
            "postal_code": "03064",
            "telephone_number": "603-882-6333",
            "fax_number": "603-889-5460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KRISTY",
        "middle_name": "MAY",
        "name_prefix": "Mrs.",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "NH",
            "license": "1582",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "13Y003886NH01",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "272746",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "561822",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "626514",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "761242",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "99560056",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTY",
            "last_name": "DEJNAK",
            "middle_name": "MAY",
            "prefix": "MRS.",
            "credential": "OT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Nashua, NH

All providers in Nashua, NH · Pediatric Occupational Therapist in New Hampshire

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.