Active NPI
Kiyoko Williams, OTD
- Occupational Therapist
- Portland, OR
National Provider Identifier
1992169346
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 367851
- Practice address
- 436 SE 12TH Ave
Portland, OR 97214-1323 - Phone
- (503) 305-3088
- NPI assigned
- Apr 12, 2016
- 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 | 367851 | OR | Primary |
Addresses
Primary practice location
436 SE 12TH Ave
Portland, OR 97214-1323
Mailing address
436 SE 12TH Ave
Portland, OR 97214-1323
Phone (503) 305-3088
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220504000906 | OR | Practitioner - Occupational Therapist in Private Practice | 2062809791 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 367851 | OR | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1460419200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642032000000",
"number": "1992169346",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "436 SE 12TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972141323",
"telephone_number": "503-305-3088"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "436 SE 12TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972141323",
"telephone_number": "503-305-3088"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "KIYOKO",
"name_prefix": "Dr.",
"credential": "OTD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-04-12",
"last_updated": "2022-01-13",
"certification_date": "2022-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "OR",
"license": "367851",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.