Active NPI
Lagena Kay Immel, OTR
- Pediatric Occupational Therapist
- Clarksville, AR
National Provider Identifier
1275745630
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- OTR1512
- Practice address
- 1000 W Buchanan St
Clarksville, AR 72830-2252 - Phone
- (479) 754-6210
- NPI assigned
- May 5, 2007
- 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 |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | OTR1512 | AR | Primary |
Addresses
Primary practice location
1000 W Buchanan St
Clarksville, AR 72830-2252
Mailing address
PO Box 1622
Clarksville, AR 72830-1622
Phone (479) 754-2107
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 |
|---|---|---|---|
| OTR1512 | AR | MD | Pediatric Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Therapy Made Fun Inc | Past | Accepting new patients | |
| Forrester-Davis Development Center, Inc. | 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.
-
- Contractor
- Clarksville, AR
- NPI 1750593828
-
- Developmentally Disabled Services Day Training Agency
- Clarksville, AR
- NPI 1184784670
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1275745630",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1622",
"city": "CLARKSVILLE",
"state": "AR",
"postal_code": "728301622",
"telephone_number": "479-754-2107"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 W BUCHANAN ST",
"city": "CLARKSVILLE",
"state": "AR",
"postal_code": "728302252",
"telephone_number": "479-754-6210"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IMMEL",
"first_name": "LAGENA",
"middle_name": "KAY",
"name_prefix": "Ms.",
"credential": "OTR",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "AR",
"license": "OTR1512",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarksville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.