Active NPI
Nicole Krysta Mayo, OTR/L
- Occupational Therapist
- Waltham, MA
National Provider Identifier
1922441096
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 10846
- Practice address
- 210 Bear Hill Rd
Waltham, MA 02451-1025 - Phone
- (781) 790-8479
- NPI assigned
- Apr 9, 2013
- Sex
- Female
- Sole proprietor
- No
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 | 10846 | MA | Primary |
Addresses
Primary practice location
210 Bear Hill Rd
Waltham, MA 02451-1025
Mailing address
210 Bear Hill Rd
Waltham, MA 02451-1025
Phone (781) 790-8479
Other practice location 1
555 Amory St
Jamaica Plain, MA 02130-2652
Phone (617) 383-6522
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 |
|---|---|---|---|
| 10846 | MA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cortica Developmental Therapies PA | 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 and National Provider Directory roles.
-
- Multi-Specialty Clinic/Center
- Plano, TX
- NPI 1619554680
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1365465600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599782400000",
"number": "1922441096",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 BEAR HILL RD",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024511025",
"telephone_number": "781-790-8479"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 BEAR HILL RD",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024511025",
"telephone_number": "781-790-8479"
}
],
"practiceLocations": [
{
"address_1": "555 Amory St",
"address_purpose": "LOCATION",
"city": "Jamaica Plain",
"state": "MA",
"postal_code": "021302652",
"country_code": "US",
"telephone_number": "617-383-6522",
"fax_number": "617-383-6520",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MAYO",
"first_name": "NICOLE",
"middle_name": "KRYSTA",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-04-09",
"last_updated": "2020-09-11",
"certification_date": "2020-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MA",
"license": "10846",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waltham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.