Active NPI
Kimberly Roberts
- Occupational Therapist
- Mooresville, NC
National Provider Identifier
1902136088
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT 17475
- Practice address
- 117 S Audubon Ave
Mooresville, NC 28117-9141 - Phone
- (812) 818-0108
- NPI assigned
- Jan 12, 2010
- Last updated
- Sep 20, 2021
- 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 | OT 17475 | FL | Primary |
Addresses
Primary practice location
117 S Audubon Ave
Mooresville, NC 28117-9141
Mailing address
117 S Audubon Ave
Mooresville, NC 28117-9141
Phone (812) 818-0108
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT 17475 | FL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1263254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632096000000",
"number": "1902136088",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "117 S AUDUBON AVE",
"city": "MOORESVILLE",
"state": "NC",
"postal_code": "281179141",
"telephone_number": "812-818-0108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "117 S AUDUBON AVE",
"city": "MOORESVILLE",
"state": "NC",
"postal_code": "281179141",
"telephone_number": "812-818-0108"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "KIMBERLY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-01-12",
"last_updated": "2021-09-20",
"certification_date": "2021-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "OT 17475",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mooresville, NC
- Misty Roberson
- Robert C. Gray Jr., DDS, P.a.
- Catherine Ann Roberts, NP
- Charles Waitsel Roberts IV, DDS
- Christopher Michael Roberts, LCMHC, NCC
- Angela Kay Robertson-Turner, FNP
- Hillary Ann Robinowitz-Elins, M.D.
- James Alexander Robinson, D.P.M.
- Jason Richard Robinson, DDS
- Megan Lee Robinson, NCC, LCMHCA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.