NPIMap

Individual provider Active NPI

Kyle Lemoine Sanders, OT/L

  • Occupational Therapist
  • Broken Arrow, OK
National Provider Identifier
1841470143
Registry record updated Jul 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
1367 Issued in OK
Practice address
2208 N Yellowood Ave
Broken Arrow, OK 74012-9102
Phone
(918) 286-1261
Fax
(918) 286-1265
NPI assigned
Nov 5, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 22, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 1367 OK Primary

Addresses

Primary practice location

2208 N Yellowood Ave
Broken Arrow, OK 74012-9102

Mailing address

2208 N Yellowood Ave
Broken Arrow, OK 74012-9102
Phone (918) 286-1261

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
1367OKMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Four State Rehabilitation Past Accepting new patients
Autism Behavior Consultants of Oklahoma, LTD Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1194220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1248220800000",
    "number": "1841470143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2208 N YELLOWOOD AVE",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740129102",
            "telephone_number": "918-286-1261",
            "fax_number": "918-286-1265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2208 N YELLOWOOD AVE",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740129102",
            "telephone_number": "918-286-1261",
            "fax_number": "918-286-1265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDERS",
        "first_name": "KYLE",
        "middle_name": "LEMOINE",
        "name_prefix": "Mr.",
        "credential": "OT/L",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-11-05",
        "last_updated": "2009-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "OK",
            "license": "1367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Broken Arrow, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2009; 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.