Active NPI
Kevin J Maxon
- Occupational Therapist
- Pelham, AL
National Provider Identifier
1205166097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 2113
- Practice address
- 245 Cahaba Valley Pkwy
Pelham, AL 35124-2216 - Phone
- (205) 942-6820
- NPI assigned
- Dec 30, 2009
- Sex
- Male
- 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 | 2113 | AR | Primary |
Addresses
Primary practice location
245 Cahaba Valley Pkwy
Pelham, AL 35124-2216
Mailing address
4500 Old Greenwood Rd
Fort Smith, AR 72903-6417
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 |
|---|---|---|---|
| 2113 | AR | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1262131200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1262131200000",
"number": "1205166097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4500 OLD GREENWOOD RD",
"city": "FORT SMITH",
"state": "AR",
"postal_code": "729036417"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "245 CAHABA VALLEY PKWY",
"city": "PELHAM",
"state": "AL",
"postal_code": "351242216",
"telephone_number": "205-942-6820"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAXON",
"first_name": "KEVIN",
"middle_name": "J",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-12-30",
"last_updated": "2009-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "AR",
"license": "2113",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pelham, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 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.