Kimberly Wagner, MS, OTRL

Primary specialty

SpecialistTaxonomy code 174400000X

License

5201001795 Issued in MI

Practice address

23936 Michigan Ave
Dearborn, MI 48124-1833

Phone

(313) 278-4601

NPI assigned

Mar 7, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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 and National Provider Directory roles.

• Starr Commonwealth

  • Community/Behavioral Health Agency
  • Battle Creek, MI
  • NPI 1326421959
  NPD (past)

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

{
    "created_epoch": "1425686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564444800000",
    "number": "1861885477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15045 BELMONT AVE",
            "city": "ALLEN PARK",
            "state": "MI",
            "postal_code": "481011605",
            "telephone_number": "313-378-6648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23936 MICHIGAN AVE",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481241833",
            "telephone_number": "313-278-4601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "KIMBERLY",
        "credential": "MS, OTRL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-07",
        "last_updated": "2019-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MI",
            "license": "5201001795",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MI",
            "license": "5201001795",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Panda",
            "affiliation": "N",
            "endpointDescription": "Starr medical files",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "15045 Belmont Ave",
            "city": "Allen Park",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481011605",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ariana Cassiel Wade
• Willie Wadford III
• Elizabeth Wadkins
• Tyisha Wadlington
• Jamie Nicole Wadsworth
• Baseem Wahab
• Nadine Wahidi
• Madelyn Rose Waidelich
• Laverne Wainwright, APRN,BC
• Sherri Wais, RPH

• Specialist in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Specialist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2019; 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.