Active NPI
Kelsey Wagner
- Pediatric Occupational Therapist
- Rensselaer, IN
National Provider Identifier
1801269543
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- 31006833A
- Practice address
- 4754 W 50 N
Rensselaer, IN 47978-8557 - Phone
- (219) 863-3787
- NPI assigned
- Nov 3, 2015
- Last updated
- Jul 29, 2020
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Athletic Trainer | 2255A2300X | |||
| Pediatric Occupational Therapist | 225XP0200X | 31006833A | IN | Primary |
Addresses
Primary practice location
4754 W 50 N
Rensselaer, IN 47978-8557
Mailing address
35 Executive Dr Ste 5
Lafayette, IN 47905-4881
Phone (765) 446-8300
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 |
|---|---|---|---|
| 31006833A | IN | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1446508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595980800000",
"number": "1801269543",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "35 EXECUTIVE DR STE 5",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479054881",
"telephone_number": "765-446-8300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4754 W 50 N",
"city": "RENSSELAER",
"state": "IN",
"postal_code": "479788557",
"telephone_number": "219-863-3787"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "KELSEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-11-03",
"last_updated": "2020-07-29",
"certification_date": "2020-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": false
},
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "IN",
"license": "31006833A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rensselaer, IN
- Susan K Tolleson, PTA
- Julian Y Ungar-Sargon, M.D., PHD
- Angela Renee Urbano, PHARMD, RPH
- Vanessa Heather Vanderhere, PT
- Alejandro A. Vega, M.D.
- James G Wakefield III, M.D.
- Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-2020)
- Walgreen Co (Walgreens #21380)
- Taylor Jeanne Walsh, PT, DPT
- Walter L Curry DPM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.