Kaelyn Nicole Gibson, MSOT, OTR

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

287133 Issued in KY

Practice address

2427 Russellville Rd
Bowling Green, KY 42101-3980

Phone

(270) 936-7472

Fax

(317) 520-8200

NPI assigned

Aug 1, 2023

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

• Kaelyn Nicole Agnew Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Hopebridge, LLC

  • Pediatric Occupational Therapist
  • Bowling Green, KY
  • NPI 1710405774
  NPD (past)

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

{
    "created_epoch": "1690848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712707200000",
    "number": "1134801103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 DEPAUW BLVD STE 3070",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462686135",
            "telephone_number": "855-324-0885",
            "fax_number": "317-520-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2427 RUSSELLVILLE RD",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421013980",
            "telephone_number": "270-936-7472",
            "fax_number": "317-520-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "KAELYN",
        "middle_name": "NICOLE",
        "credential": "MSOT, OTR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-01",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "KY",
            "license": "287133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAELYN",
            "last_name": "AGNEW",
            "middle_name": "NICOLE",
            "credential": "MSOT, OTR",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Abdol Ghayoumi, D.C.
• Nazanin Ghazisharif, D.D.S.
• Gibson Interventions, LLC
• Georgeanna Gibson, LPCC
• Jane Catherine Gibson, M.D.
• Nicole Lynn Gibson, BCBA
• Roger Gibson
• Todd Michael Gibson
• Erica Gidcumb, APRN
• Amanda L Giebink, RD

• Occupational Therapist in Bowling Green, KY
• Providers in Bowling Green, KY by specialty
• Occupational Therapist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2024; 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.