Kathleen Marie Wagner, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

OT-A625 Issued in AR

Practice address

979 Weston St
Pea Ridge, AR 72751-2628

Phone

(479) 451-8181

NPI assigned

Oct 27, 2011

Last updated

Oct 20, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 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.

• Physician's Therapy Group, LLC

  • Speech-Language Pathologist
  • Springdale, AR
  • NPI 1144276585
  NPD (past)

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

{
    "created_epoch": "1319673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697760000000",
    "number": "1871879452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "979 WESTON ST",
            "city": "PEA RIDGE",
            "state": "AR",
            "postal_code": "727512628",
            "telephone_number": "479-451-8181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "979 WESTON ST",
            "city": "PEA RIDGE",
            "state": "AR",
            "postal_code": "727512628",
            "telephone_number": "479-451-8181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "KATHLEEN",
        "middle_name": "MARIE",
        "credential": "COTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-10-27",
        "last_updated": "2023-10-20",
        "certification_date": "2023-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "AR",
            "license": "OT-A625",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "186686721",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chloe Thornton
• Keri L. Timmons, MS, LPC, NCC
• Ryan Alexander Vance
• Leslie Anne Vest
• Brandy Lee Vines
• Walmart Inc. (Walmart Pharmacy 10-6971)
• Kacie B White, OTR/L
• Tyler D White, LPC
• Wildflower Pediatric Therapy, LLC
• Shelia Diana Wilkerson, MS,PT

• Occupational Therapy Assistant in Pea Ridge, AR
• Providers in Pea Ridge, AR by specialty
• Occupational Therapy Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2023; 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.