Active NPI
Kenneth Paul Haagsma, OCCUPATIONAL THERAPI
- Occupational Therapist
- Grandville, MI
National Provider Identifier
1639363088
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 5201000994
- Practice address
- 4072 Lila Ave SW
Grandville, MI 49418 - Phone
- (616) 644-1050
- NPI assigned
- Aug 29, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 5201000994 | MI | Primary |
Addresses
Primary practice location
4072 Lila Ave SW
Grandville, MI 49418
Mailing address
4072 Lila Ave SW
Grandville, MI 49418
Phone (616) 644-1050
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 |
|---|---|---|---|
| 5201000994 | MI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1188345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1188345600000",
"number": "1639363088",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4072 LILA AVE SW",
"city": "GRANDVILLE",
"state": "MI",
"postal_code": "49418",
"telephone_number": "616-644-1050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4072 LILA AVE SW",
"city": "GRANDVILLE",
"state": "MI",
"postal_code": "49418",
"telephone_number": "616-644-1050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAAGSMA",
"first_name": "KENNETH",
"middle_name": "PAUL",
"name_prefix": "Mr.",
"credential": "OCCUPATIONAL THERAPI",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-08-29",
"last_updated": "2007-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MI",
"license": "5201000994",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grandville, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 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.