Active NPI
Kathie Domenico
- Occupational Therapy Assistant
- Springfield, MO
National Provider Identifier
1922327709
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 2005018686
- Practice address
- 314 E Cardinal St
Springfield, MO 65810-1734 - Phone
- (417) 234-7235
- Fax
- (417) 823-9937
- NPI assigned
- May 19, 2010
- 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 Therapy Assistant | 224Z00000X | 2005018686 | MO | Primary |
Addresses
Primary practice location
314 E Cardinal St
Springfield, MO 65810-1734
Mailing address
314 E Cardinal St
Springfield, MO 65810-1734
Phone (417) 234-7235
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 |
|---|---|---|---|
| 2005018686 | MO | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1274227200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1274227200000",
"number": "1922327709",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "314 E CARDINAL ST",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658101734",
"telephone_number": "417-234-7235",
"fax_number": "417-823-9937"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "314 E CARDINAL ST",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658101734",
"telephone_number": "417-234-7235",
"fax_number": "417-823-9937"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMENICO",
"first_name": "KATHIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-05-19",
"last_updated": "2010-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "MO",
"license": "2005018686",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.