Active NPI
Cory A Kimmerly, COTA/L
- Occupational Therapy Assistant
- Oxford, NC
National Provider Identifier
1780161257
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 11917
- Practice address
- 500 Prospect Ave
Oxford, NC 27565-2543 - Phone
- (919) 693-1531
- NPI assigned
- Jul 26, 2018
- 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 |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 11917 | NC | Primary |
Addresses
Primary practice location
500 Prospect Ave
Oxford, NC 27565-2543
Mailing address
4306 Tommie Sneed Rd
Oxford, NC 27565-6959
Phone (919) 524-3515
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 |
|---|---|---|---|
| 11917 | NC | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1532563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1532563200000",
"number": "1780161257",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4306 TOMMIE SNEED RD",
"city": "OXFORD",
"state": "NC",
"postal_code": "275656959",
"telephone_number": "919-524-3515"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 PROSPECT AVE",
"city": "OXFORD",
"state": "NC",
"postal_code": "275652543",
"telephone_number": "919-693-1531"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMMERLY",
"first_name": "CORY",
"middle_name": "A",
"credential": "COTA/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-07-26",
"last_updated": "2018-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "NC",
"license": "11917",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oxford, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.