Active NPI
Kaitlin Lackey
- Pediatric Occupational Therapist
- Tyrone, GA
National Provider Identifier
1407215361
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- OT006357
- Practice address
- 105 Glendalough Court
Suite H
Tyrone, GA 30290 - Phone
- (678) 632-6765
- Fax
- (678) 550-7931
- NPI assigned
- Feb 19, 2016
- Sex
- Female
- Sole proprietor
- No
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 | OT006357 | GA | Primary |
Addresses
Primary practice location
105 Glendalough Court
Suite H
Tyrone, GA 30290
Mailing address
117 Hardy Road
Senoia, GA 30267
Phone (678) 371-1061
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 |
|---|---|---|---|
| OT006357 | GA | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1455840000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1455840000000",
"number": "1407215361",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "117 HARDY ROAD",
"city": "SENOIA",
"state": "GA",
"postal_code": "30267",
"telephone_number": "678-371-1061"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 GLENDALOUGH COURT",
"address_2": "SUITE H",
"city": "TYRONE",
"state": "GA",
"postal_code": "30290",
"telephone_number": "678-632-6765",
"fax_number": "678-550-7931"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LACKEY",
"first_name": "KAITLIN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-02-19",
"last_updated": "2016-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "GA",
"license": "OT006357",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyrone, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.