Active NPI
Kele Elizabeth Wilson
- Occupational Therapist
- Ward, AR
National Provider Identifier
1992936082
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OTR772
- Practice address
- 1500 Wilson Loop Road
Ward, AR 72176 - Phone
- (501) 941-5630
- Fax
- (501) 843-2270
- NPI assigned
- Aug 6, 2009
- 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 | OTR772 | AR | Primary |
Addresses
Primary practice location
1500 Wilson Loop Road
Ward, AR 72176
Mailing address
P.O. Box 333
Ward, AR 72176
Phone (501) 941-5630
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 129951721 | Medicaid | AR |
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 |
|---|---|---|---|
| OTR772 | AR | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Allied Therapy and Consulting Services, PA | Past | Accepting new patients | |
| Beyond Boundaries, Inc | Occupational Therapist | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Specialist
- North Little Rock, AR
- NPI 1134185937
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1249516800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1249516800000",
"number": "1992936082",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 333",
"city": "WARD",
"state": "AR",
"postal_code": "72176",
"telephone_number": "501-941-5630",
"fax_number": "501-843-2270"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 WILSON LOOP ROAD",
"city": "WARD",
"state": "AR",
"postal_code": "72176",
"telephone_number": "501-941-5630",
"fax_number": "501-843-2270"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "KELE",
"middle_name": "ELIZABETH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-08-06",
"last_updated": "2009-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "AR",
"license": "OTR772",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "129951721",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ward, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.