Active NPI
Kelly Kubacki, OTR
- Occupational Therapist
- Fort Mill, SC
National Provider Identifier
1447893839
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- Practice address
- 522 Sixth Baxter Xing
Fort Mill, SC 29708-6613 - Phone
- (803) 752-4780
- NPI assigned
- Oct 18, 2019
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | Primary |
Addresses
Primary practice location
522 Sixth Baxter Xing
Fort Mill, SC 29708-6613
Mailing address
W276S9075 Hidden Lakes Dr
Mukwonago, WI 53149-9654
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5631 | SC | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1571356800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571356800000",
"number": "1447893839",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "W276S9075 HIDDEN LAKES DR",
"city": "MUKWONAGO",
"state": "WI",
"postal_code": "531499654"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "522 SIXTH BAXTER XING",
"city": "FORT MILL",
"state": "SC",
"postal_code": "297086613",
"telephone_number": "803-752-4780"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUBACKI",
"first_name": "KELLY",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-10-18",
"last_updated": "2019-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Mill, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 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.