Katelyn Michelle Fulwider

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

2017029562 Issued in MO

Practice address

1575 Parker Rd
Nixa, MO 65714-9522

Phone

(417) 631-6072

NPI assigned

Aug 18, 2022

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 18, 2022.

{
    "created_epoch": "1660780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660780800000",
    "number": "1043938780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1575 PARKER RD",
            "city": "NIXA",
            "state": "MO",
            "postal_code": "657149522",
            "telephone_number": "417-631-6072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1575 PARKER RD",
            "city": "NIXA",
            "state": "MO",
            "postal_code": "657149522",
            "telephone_number": "417-631-6072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULWIDER",
        "first_name": "KATELYN",
        "middle_name": "MICHELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-18",
        "last_updated": "2022-08-18",
        "certification_date": "2022-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "MO",
            "license": "2017029562",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kelly L. Fournier, CPM
• Tamara L. Fusco, MD
• Garrett Edward Gabel, DC
• Caleb Allen Garde
• Jennifer Garner, DPT
• Erin Elizabeth Gdovin, PLPC

• All providers in Nixa, MO
• Occupational Therapy Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 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.

Verify at the official NPI Registry.