Active NPI
Kim Marie Vander Galien, COTA
- Occupational Therapy Assistant
- Beaver Dam, WI
National Provider Identifier
1699948232
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 793-027
- Practice address
- 104 Fakes CT
Beaver Dam, WI 53916-2699 - Phone
- (920) 219-4941
- NPI assigned
- Apr 3, 2008
- 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 Therapy Assistant | 224Z00000X | 793-027 | WI | Primary |
Addresses
Primary practice location
104 Fakes CT
Beaver Dam, WI 53916-2699
Mailing address
108 Windmill Way
Randolph, WI 53956-1340
Phone (920) 382-0108
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699948232 | Medicaid | WI |
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 |
|---|---|---|---|
| 793-027 | WI | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633305600000",
"number": "1699948232",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "108 WINDMILL WAY",
"city": "RANDOLPH",
"state": "WI",
"postal_code": "539561340",
"telephone_number": "920-382-0108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 FAKES CT",
"city": "BEAVER DAM",
"state": "WI",
"postal_code": "539162699",
"telephone_number": "920-219-4941"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDER GALIEN",
"first_name": "KIM",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "COTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-04-03",
"last_updated": "2021-10-04",
"certification_date": "2021-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "WI",
"license": "793-027",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1699948232",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Beaver Dam, WI
- University of Wisconsin Medical Foundation Inc
- Unmasked Expressive Therapies
- David Charles Utrie, D.D.S.
- Angela Kay Van Ooyen, MS, CCC-SLP
- Ellen Marie Vander Galien
- William Vansusteren, MS, LPC-IT
- Vein Care Associates S.C.
- Prabhu Venkataraman, LPC-IT
- Victor W. Caceres, M.D.,S.C.
- Lynda K Vielbig, CRNA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.