Individual provider Active NPI

Kristin Ann Ellingsen, OTR/L

  • Pediatric Occupational Therapist
  • New City, NY
National Provider Identifier
1730462995
Registry record updated Sep 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
License
015761-1 Issued in NY
Practice address
9 Glenn LN
New City, NY 10956-3011
Phone
(845) 270-2925
NPI assigned
Sep 23, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Occupational Therapist 225XP0200X 015761-1 NY Primary
Pediatric Occupational Therapist 225XP0200X 46TR00508000 NJ

Addresses

Primary practice location

9 Glenn LN
New City, NY 10956-3011

Mailing address

9 Glenn LN
New City, NY 10956-3011
Phone (845) 270-2925

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

LicenseStateTypeSpecialty
46TR00508000NJMDPediatric Occupational Therapist
015761-1NYMDPediatric Occupational Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1316736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316736000000",
    "number": "1730462995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 GLENN LN",
            "city": "NEW CITY",
            "state": "NY",
            "postal_code": "109563011",
            "telephone_number": "845-270-2925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 GLENN LN",
            "city": "NEW CITY",
            "state": "NY",
            "postal_code": "109563011",
            "telephone_number": "845-270-2925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLINGSEN",
        "first_name": "KRISTIN",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-23",
        "last_updated": "2011-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "NY",
            "license": "015761-1",
            "primary": true
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "NJ",
            "license": "46TR00508000",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New City, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.