NPIMap

Individual provider Active NPI

Martin M Kiongo, OTR/L

  • Occupational Therapist
  • Vincennes, IN
National Provider Identifier
1871928986
Registry record updated Sep 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
31005554A Issued in IN
Practice address
3801 Old Bruceville Rd
Vincennes, IN 47591-3889
Phone
(812) 886-4677
NPI assigned
Sep 9, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2013

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 31005554A IN Primary

Addresses

Primary practice location

3801 Old Bruceville Rd
Vincennes, IN 47591-3889

Mailing address

1925 High Eagle TRL Apt 878
Indianapolis, IN 46224-4257

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
31005554AINMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Trucare Home Care LLC Current Accepting new patients
Trucare Home Health LLC Current 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": "1378684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378684800000",
    "number": "1871928986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 HIGH EAGLE TRL APT 878",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462244257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 OLD BRUCEVILLE RD",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475913889",
            "telephone_number": "812-886-4677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIONGO",
        "first_name": "MARTIN",
        "middle_name": "M",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-09-09",
        "last_updated": "2013-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IN",
            "license": "31005554A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vincennes, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2013; 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.