Active NPI
Kelle Malkewitz, CTRS
- Recreation Therapist
- Poultney, VT
National Provider Identifier
1902548019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Recreation Therapist
- License
- 23309
- Practice address
- 2854 Highland Gray Rd
Poultney, VT 05764-9124 - Phone
- (802) 287-9610
- NPI assigned
- Apr 9, 2022
- Last updated
- Apr 9, 2022
- 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 |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | 23309 | VT | Primary |
Addresses
Primary practice location
2854 Highland Gray Rd
Poultney, VT 05764-9124
Mailing address
2854 Highland Gray Rd
Poultney, VT 05764-9124
Phone (802) 287-9610
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 23309 | Other | NATIONAL COUNCIL FOR THERAPEUTIC RECREATION CERTIFICATION |
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 |
|---|---|---|---|
| 23309 | VT | MD | Recreation Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649462400000",
"number": "1902548019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2854 HIGHLAND GRAY RD",
"city": "POULTNEY",
"state": "VT",
"postal_code": "057649124",
"telephone_number": "802-287-9610"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2854 HIGHLAND GRAY RD",
"city": "POULTNEY",
"state": "VT",
"postal_code": "057649124",
"telephone_number": "802-287-9610"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALKEWITZ",
"first_name": "KELLE",
"credential": "CTRS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-04-09",
"last_updated": "2022-04-09",
"certification_date": "2022-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "225800000X",
"taxonomy_group": "",
"desc": "Recreation Therapist",
"state": "VT",
"license": "23309",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATIONAL COUNCIL FOR THERAPEUTIC RECREATION CERTIFICATION",
"identifier": "23309",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Poultney, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.