Kacy Moses Gustafson, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

2572 Issued in SC

Practice address

350 Austin Graybill Rd
North Augusta, SC 29860-9251

Phone

(803) 278-4272

NPI assigned

Sep 30, 2006

Last updated

Jul 8, 2007By 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1159574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1952494338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2421 CAMELOT DR",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309043381",
            "telephone_number": "706-799-3160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 AUSTIN GRAYBILL RD",
            "city": "NORTH AUGUSTA",
            "state": "SC",
            "postal_code": "298609251",
            "telephone_number": "803-278-4272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "KACY",
        "middle_name": "MOSES",
        "credential": "COTA/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "SC",
            "license": "2572",
            "primary": true
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "GA",
            "license": "OTA000860",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Makena Uyen Griffis
• Simone Grigsby
• Christy Carter Grover
• Peyton Vacala Gruber, PA-S
• Lindsey Guilbeau
• Ivonne De Liz Guzman Martinez, RBT
• Michael Cory Hall, DMD
• Sarah Hall
• Benjamin Brent Hamilton
• Judith L Hamilton, MSW

• Occupational Therapy Assistant in North Augusta, SC
• Providers in North Augusta, SC by specialty
• Occupational Therapy Assistant in South Carolina

• 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.

Verify at the official NPI Registry.