Active NPI
Kim Hagstrom, OTR/L
- Mental Health Occupational Therapist
- West Brentwood, NY
National Provider Identifier
1730917055
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Occupational Therapist
- License
- 004167-1
- Practice address
- 998 Crooked Hill Rd
West Brentwood, NY 11717-1019 - Phone
- (631) 761-2780
- Fax
- (631) 761-3103
- NPI assigned
- Jul 26, 2024
- 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 |
|---|---|---|---|---|
| Mental Health Occupational Therapist | 225XM0800X | 004167-1 | NY | Primary |
Addresses
Primary practice location
998 Crooked Hill Rd
West Brentwood, NY 11717-1019
Mailing address
998 Crooked Hill Rd
West Brentwood, NY 11717-1019
Phone (631) 761-2780
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004167 | NY | MD | Mental Health Counselor |
| 004167-1 | NY | MD | Mental Health Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721952000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721952000000",
"number": "1730917055",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "998 CROOKED HILL RD",
"city": "WEST BRENTWOOD",
"state": "NY",
"postal_code": "117171019",
"telephone_number": "631-761-2780",
"fax_number": "631-761-3103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "998 CROOKED HILL RD",
"city": "WEST BRENTWOOD",
"state": "NY",
"postal_code": "117171019",
"telephone_number": "631-761-2780",
"fax_number": "631-761-3103"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAGSTROM",
"first_name": "KIM",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-07-26",
"last_updated": "2024-07-26",
"certification_date": "2024-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "225XM0800X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Mental Health",
"state": "NY",
"license": "004167-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Brentwood, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.