Active NPI
Kimberly Haugen Forehand, OTR
- Occupational Therapist
- South Bend, IN
National Provider Identifier
1457766479
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 31005694A
- Practice address
- 2012 Ironwood Cir
Suite 230
South Bend, IN 46635-1888 - Phone
- (574) 387-4049
- Fax
- (574) 387-4062
- NPI assigned
- Jun 28, 2014
- 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 | 31005694A | IN | Primary |
Addresses
Primary practice location
2012 Ironwood Cir
Suite 230
South Bend, IN 46635-1888
Mailing address
2146 E Ash Maple LN
Elkhart, IN 46514-9011
Phone (513) 532-5056
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 |
|---|---|---|---|
| 31005694A | IN | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children'S Therapy Innovations Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Intellectual Disabilities Intermediate Care Facility
- South Bend, IN
- NPI 1407166192
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1403913600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1403913600000",
"number": "1457766479",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2146 E ASH MAPLE LN",
"city": "ELKHART",
"state": "IN",
"postal_code": "465149011",
"telephone_number": "513-532-5056"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2012 IRONWOOD CIR",
"address_2": "SUITE 230",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466351888",
"telephone_number": "574-387-4049",
"fax_number": "574-387-4062"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOREHAND",
"first_name": "KIMBERLY",
"middle_name": "HAUGEN",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-06-28",
"last_updated": "2014-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IN",
"license": "31005694A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.