Marie Macaraeg Kofnovec, COTA

Primary specialty

Pediatric Neurodevelopmental Disabilities PhysicianTaxonomy code 2080P0008X

License

224Z00000X Issued in TX

Practice address

630 Stoneglen Dr Ste B
Keller, TX 76248-3626

Phone

(817) 734-6515

Fax

(817) 717-8584

NPI assigned

Nov 22, 2021

Last updated

Nov 22, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Allison's Therapy Corner, LLC

  dba Allison's Therapy Corner

  • Behavior Analyst
  • Fort Worth, TX
  • NPI 1184195737
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1637539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637539200000",
    "number": "1801553110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5724 HUNTERS BEND LN",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752492303",
            "telephone_number": "972-408-7012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 STONEGLEN DR STE B",
            "city": "KELLER",
            "state": "TX",
            "postal_code": "762483626",
            "telephone_number": "817-734-6515",
            "fax_number": "817-717-8584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOFNOVEC",
        "first_name": "MARIE",
        "middle_name": "MACARAEG",
        "credential": "COTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-22",
        "last_updated": "2021-11-22",
        "certification_date": "2021-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0008X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neurodevelopmental Disabilities",
            "state": "TX",
            "license": "224Z00000X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COTA",
            "identifier": "464765",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "SimplePractice",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "630 Stoneglen Dr Ste B",
            "city": "Keller",
            "state": "TX",
            "country_code": "US",
            "postal_code": "762483626",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Aesha Knapper
• Caitlin Kneblik, PT
• Kristy Lee Knife Chief
• Emily Knight, DPT
• Christopher Knowles, PHARMD
• Sharon Kay Kohanyuk, LPC
• Cheryl Landry Kokkinis, OTR
• Sushma Komandur, RPH
• Kristin L. Kosanke, M.D.
• Tanner Kowaleski, LPC ASSOCIATE

• Pediatric Neurodevelopmental Disabilities Physician in Keller, TX
• Providers in Keller, TX by specialty
• Pediatric Neurodevelopmental Disabilities Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 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.

Verify at the official NPI Registry.