Kristine Ryan, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

5521 Issued in CA

Practice address

12900B Garden Grove Blvd Ste 235
Garden Grove, CA 92843-2027

Phone

(714) 750-9700

Fax

(714) 750-9797

NPI assigned

Feb 25, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Kid Fundamentals Therapy Center, Inc.

  • Pediatric Occupational Therapist
  • Garden Grove, CA
  • NPI 1518529635
  NPD

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

{
    "created_epoch": "1614211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729036800000",
    "number": "1821682279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1726",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926841726",
            "telephone_number": "714-750-9700",
            "fax_number": "714-750-9797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12900B GARDEN GROVE BLVD STE 235",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928432027",
            "telephone_number": "714-750-9700",
            "fax_number": "714-750-9797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYAN",
        "first_name": "KRISTINE",
        "credential": "COTA/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-25",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "CA",
            "license": "5521",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "5521",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ruso
• Russo Chiropractic Corp.
• Michael Russo, D.C. QME
• Richard Michael Rutledge, D.O.
• Ryan Blossey Chiropractic, Inc
• S. Truong Dental Corporation
• S.S. Kim, D.D.S., Inc.
• Arooj Saadat
• Steven Mark Saba, OD
• Anjanette Nicole Llanto Sabado

• Occupational Therapy Assistant in Garden Grove, CA
• Providers in Garden Grove, CA by specialty
• Occupational Therapy Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2024; 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.