NPIMap

Individual provider Active NPI

Kristen S. Wiese, MA, OTR/L

  • Occupational Therapist
  • Los Ranchos, NM
National Provider Identifier
1841473527
Registry record updated Apr 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
2414 Issued in NM
Practice address
608 Bledsoe Rd NW
Los Ranchos, NM 87107-6219
Phone
(505) 908-0717
NPI assigned
Dec 17, 2007
Last updated
Apr 12, 2010By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 12, 2010

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 2414 NM Primary
Human Factors Occupational Therapist 225XH1300X 2414 NM
Neurorehabilitation Occupational Therapist 225XN1300X 2414 NM
Pediatric Occupational Therapist 225XP0200X 2414 NM

Addresses

Primary practice location

608 Bledsoe Rd NW
Los Ranchos, NM 87107-6219

Mailing address

1104 Salamanca St NW
Albuquerque, NM 87107-5626
Phone (505) 908-0717

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
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
2414NMMDPediatric Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Kidsbridge Occupational Therapy Past Accepting new patients
Kidsbridge 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, 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": "1197849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1271030400000",
    "number": "1841473527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1104 SALAMANCA ST NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871075626",
            "telephone_number": "505-908-0717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "608 BLEDSOE RD NW",
            "city": "LOS RANCHOS",
            "state": "NM",
            "postal_code": "871076219",
            "telephone_number": "505-908-0717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIESE",
        "first_name": "KRISTEN",
        "middle_name": "S.",
        "credential": "MA, OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-12-17",
        "last_updated": "2010-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NM",
            "license": "2414",
            "primary": true
        },
        {
            "code": "225XH1300X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Human Factors",
            "state": "NM",
            "license": "2414",
            "primary": false
        },
        {
            "code": "225XN1300X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Neurorehabilitation",
            "state": "NM",
            "license": "2414",
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "NM",
            "license": "2414",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Ranchos, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2010; 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.