Active NPI
Kathleen Alyson Macconnell, MS,OTR/L
- Occupational Therapist
- Ladson, SC
National Provider Identifier
1639425465
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 2556
- Practice address
- 105 Southernwood Dr
Ladson, SC 29456-3941 - Phone
- (843) 822-8859
- NPI assigned
- Jul 30, 2012
- Sex
- Female
- 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 | 2556 | SC | Primary |
Addresses
Primary practice location
105 Southernwood Dr
Ladson, SC 29456-3941
Mailing address
105 Southernwood Dr
Ladson, SC 29456-3941
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2556 | SC | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Impact Therapy, LLC | 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.
-
- Physical Therapist
- Mt Pleasant, SC
- NPI 1336325984
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343606400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1343606400000",
"number": "1639425465",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 SOUTHERNWOOD DR",
"city": "LADSON",
"state": "SC",
"postal_code": "294563941"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 SOUTHERNWOOD DR",
"city": "LADSON",
"state": "SC",
"postal_code": "294563941",
"telephone_number": "843-822-8859"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACCONNELL",
"first_name": "KATHLEEN",
"middle_name": "ALYSON",
"credential": "MS,OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-07-30",
"last_updated": "2012-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "SC",
"license": "2556",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ladson, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.