Active NPI
Kelly Tyler
- Occupational Therapist
- San Diego, CA
National Provider Identifier
1982145397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT17193
- Practice address
- 3760 Convoy St Ste 204
San Diego, CA 92111-3744 - Phone
- (858) 514-0375
- NPI assigned
- Mar 17, 2017
- 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 | OT17193 | CA | Primary |
Addresses
Primary practice location
3760 Convoy St Ste 204
San Diego, CA 92111-3744
Mailing address
1086 Quail Gardens CT
Encinitas, CA 92024-2782
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 |
|---|---|---|---|
| OT17193 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1489708800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489708800000",
"number": "1982145397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1086 QUAIL GARDENS CT",
"city": "ENCINITAS",
"state": "CA",
"postal_code": "920242782"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3760 CONVOY ST STE 204",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921113744",
"telephone_number": "858-514-0375"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TYLER",
"first_name": "KELLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-03-17",
"last_updated": "2017-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "OT17193",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.