Individual provider Active NPI

Kathryn Kiblen

  • Occupational Therapist
  • Windsor, CO
National Provider Identifier
1790857761
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
0005025 Issued in CO
Practice address
4650 Royal Vista Cir Ste 100
Windsor, CO 80528-9321
Phone
(970) 305-5070
Fax
(970) 541-0357
NPI assigned
Nov 15, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Occupational Therapist 225XP0200X 2001008177 MO
Pediatric Occupational Therapist 225XP0200X 0005025 CO
Occupational Therapist 225X00000X 0005025 CO Primary

Addresses

Primary practice location

4650 Royal Vista Cir Ste 100
Windsor, CO 80528-9321

Mailing address

2020 Yearling Drive
Fort Collins, CO 80525-2013
Phone (913) 909-2828

Other practice location 1

607 W Lexington Ave
Independence, MO 64050-3650
Phone (816) 833-2088

Other identifiers 2

IdentifierTypeStateIssuer
34766013OtherMOBLUE CROSS BLUE SHIELD IN
475421806MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220802000433 CO Practitioner - Occupational Therapist in Private Practice 0042692428

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0005025COMDPediatric Occupational Therapist
2001008177MOMDPediatric Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Noco Pediatric OT, LLC Occupational Therapist CurrentSince Apr 27, 2022 Accepting new patients
Noco Pediatric OT, LLC Occupational Therapist CurrentSince Apr 27, 2022 Accepting new patients
Sunshine Center Inc. Pediatrics Past Accepting new patients
Noco Pediatric OT, LLC Occupational Therapist Past Accepting new patients

Locations

1931 65th Ave
Ste C
Greeley, CO 80634
Phone (970) 352-1877

4650 Royal Vista Cir
Ste 100
Windsor, CO 80528
Phone (970) 305-5070

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1790857761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 YEARLING DRIVE",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805252013",
            "telephone_number": "913-909-2828",
            "fax_number": "970-541-0357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4650 ROYAL VISTA CIR STE 100",
            "city": "WINDSOR",
            "state": "CO",
            "postal_code": "805289321",
            "telephone_number": "970-305-5070",
            "fax_number": "970-541-0357"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "607 W Lexington Ave",
            "address_purpose": "LOCATION",
            "city": "Independence",
            "state": "MO",
            "postal_code": "640503650",
            "country_code": "US",
            "telephone_number": "816-833-2088",
            "fax_number": "816-833-1105",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIBLEN",
        "first_name": "KATHRYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-15",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "MO",
            "license": "2001008177",
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "CO",
            "license": "0005025",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CO",
            "license": "0005025",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD IN",
            "identifier": "34766013",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "475421806",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Windsor, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.