Active NPI
Kimberly Diane Phillips, OT/L, CSSID
- Occupational Therapist
- Clymer, NY
National Provider Identifier
1851673859
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 004470-1
- Practice address
- 8672 E Main St
Clymer, NY 14724-9713 - Phone
- (716) 355-4444
- Fax
- (716) 355-4467
- NPI assigned
- Sep 15, 2011
- Last updated
- Sep 15, 2011
- 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 Therapist | 225X00000X | 004470-1 | NY | Primary |
Addresses
Primary practice location
8672 E Main St
Clymer, NY 14724-9713
Mailing address
7374 Dar LN
North East, PA 16428-3886
Phone (814) 725-3637
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 |
|---|---|---|---|
| 004470-1 | NY | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clymer Central School | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Local Education Agency (LEA)
- Clymer, NY
- NPI 1346397429
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316044800000",
"number": "1851673859",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7374 DAR LN",
"city": "NORTH EAST",
"state": "PA",
"postal_code": "164283886",
"telephone_number": "814-725-3637"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8672 E MAIN ST",
"city": "CLYMER",
"state": "NY",
"postal_code": "147249713",
"telephone_number": "716-355-4444",
"fax_number": "716-355-4467"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS",
"first_name": "KIMBERLY",
"middle_name": "DIANE",
"name_prefix": "Mrs.",
"credential": "OT/L, CSSID",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-09-15",
"last_updated": "2011-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NY",
"license": "004470-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clymer, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.