Active NPI
Angela G Havens, OTR
- Occupational Therapist
- Bolivar, MO
National Provider Identifier
1922142173
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 2005017969
- Practice address
- 452 S Springfield Ave
Bolivar, MO 65613-2146 - Phone
- (417) 326-3183
- Fax
- (417) 326-3184
- NPI assigned
- Feb 19, 2007
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 2005017969 | OK | Primary |
Addresses
Primary practice location
452 S Springfield Ave
Bolivar, MO 65613-2146
Mailing address
546 Cherrywood Ave
Republic, MO 65738-1381
Phone (417) 326-3183
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 |
|---|---|---|---|
| 2005017969 | OK | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1922142173",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "546 CHERRYWOOD AVE",
"city": "REPUBLIC",
"state": "MO",
"postal_code": "657381381",
"telephone_number": "417-326-3183",
"fax_number": "417-326-3184"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "452 S SPRINGFIELD AVE",
"city": "BOLIVAR",
"state": "MO",
"postal_code": "656132146",
"telephone_number": "417-326-3183",
"fax_number": "417-326-3184"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAVENS",
"first_name": "ANGELA",
"middle_name": "G",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "OK",
"license": "2005017969",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bolivar, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.