Individual provider Active NPI

Kristin Jones, COTA

  • Occupational Therapy Assistant
  • Holiday Island, AR
National Provider Identifier
1760154173
Registry record updated Oct 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
OTA1769 Issued in AR
Practice address
23 Parkcliff Dr
Holiday Island, AR 72631-8045
Phone
(147) 936-3642
NPI assigned
Oct 4, 2021
Last updated
Oct 4, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X OTA1769 AR Primary

Addresses

Primary practice location

23 Parkcliff Dr
Holiday Island, AR 72631-8045

Mailing address

23 Parkcliff Dr
Holiday Island, AR 72631-8045
Phone (147) 936-3642

Other identifiers 1

IdentifierTypeStateIssuer
OTA1769OtherARLICENSE

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
OTA1769ARMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wolf Wellness Center, PLLC CurrentSince Oct 10, 2021 Accepting new patients
Spine and Sports Therapy LLC PastSince Oct 10, 2021 Accepting new patients

Locations

23 Parkcliff Dr
Holiday Island, AR 72631
Phone (479) 363-6422

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1633305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633305600000",
    "number": "1760154173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 PARKCLIFF DR",
            "city": "HOLIDAY ISLAND",
            "state": "AR",
            "postal_code": "726318045",
            "telephone_number": "147-936-3642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 PARKCLIFF DR",
            "city": "HOLIDAY ISLAND",
            "state": "AR",
            "postal_code": "726318045",
            "telephone_number": "147-936-3642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JONES",
        "first_name": "KRISTIN",
        "credential": "COTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-04",
        "last_updated": "2021-10-04",
        "certification_date": "2021-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "AR",
            "license": "OTA1769",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "OTA1769",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Holiday Island, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 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.

Verify at the official NPI Registry.