Karlie Boomgarden, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

OTA-1178 Issued in WY

Practice address

50 W 3Rd St
Sheridan, WY 82801-3606

Phone

(406) 728-9162

NPI assigned

Mar 12, 2019

Last updated

Aug 20, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Karlie Kinner Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sherwood Group, Inc

  dba Sheridan Physical Therapy

  • Physical Therapist
  • Sheridan, WY
  • NPI 1346255130
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1552348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566259200000",
    "number": "1073071791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 W 3RD ST",
            "city": "SHERIDAN",
            "state": "WY",
            "postal_code": "828013606",
            "telephone_number": "307-672-2092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 W 3RD ST",
            "city": "SHERIDAN",
            "state": "WY",
            "postal_code": "828013606",
            "telephone_number": "406-728-9162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOMGARDEN",
        "first_name": "KARLIE",
        "credential": "COTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-12",
        "last_updated": "2019-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "WY",
            "license": "OTA-1178",
            "primary": true
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "MT",
            "license": "OTA-4076",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KARLIE",
            "last_name": "KINNER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sarah Bockman, PHARMD
• Body and Soul Wellness LLC
• Charlotte Bohren, M.S. LPC
• Georgia Fletcher Boley, MS,RD,LD,CSO
• Chelsea Bollinger, FNP
• Donald Edwin Boone, M.S.
• Grant Griffin Boostrom, PHD
• Tara Bower, PTA
• Erin Nicole Bowers
• Mary I Bowers, MD

• Occupational Therapy Assistant in Sheridan, WY
• Providers in Sheridan, WY by specialty
• Occupational Therapy Assistant in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2019; 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.