Change Academy Lake Ozark

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

016604 Issued in MO

Legal business name

CHANGE ACADEMY LAKE OZARK

Practice address

130 Calo LN
Lake Ozark, MO 65049-9208

Phone

(573) 365-2221

Fax

(573) 365-2224

NPI assigned

Sep 8, 2014

Last updated

May 22, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Denise Hagemann

Title

Otr/L

Phone

(573) 552-8007

Specialties & licenses 4

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1410134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432252800000",
    "number": "1528469772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 CALO LN",
            "city": "LAKE OZARK",
            "state": "MO",
            "postal_code": "650499208",
            "telephone_number": "573-365-2221",
            "fax_number": "573-365-2224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 CALO LN",
            "city": "LAKE OZARK",
            "state": "MO",
            "postal_code": "650499208",
            "telephone_number": "573-365-2221",
            "fax_number": "573-365-2224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHANGE ACADEMY LAKE OZARK",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-08",
        "last_updated": "2015-05-22",
        "status": "A",
        "authorized_official_last_name": "HAGEMANN",
        "authorized_official_first_name": "DENISE",
        "authorized_official_title_or_position": "OTR/L",
        "authorized_official_telephone_number": "573-552-8007"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MO",
            "license": "016604",
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MO",
            "license": "016604",
            "primary": true
        },
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "MO",
            "license": "016604",
            "primary": false
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "MO",
            "license": "016604",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Change Academy at Lake of the Ozarks
• Change Academy at Lake of the Ozarks
• Change Academy at Lake of the Ozarks
• Change Academy Lake of the Ozarks
• Change Academy Lake of the Ozarks
• Paven Clark
• Angela Sue Creasy, SLP
• Colleen Annette Cueni-Smith, P.T.
• Jean Louise Curtit-Voss, DC
• Annmarie Davis, RN

• Clinic/Center in Lake Ozark, MO
• Providers in Lake Ozark, MO by specialty
• Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.