Active NPI
Kristie Lynn Wagoner, OTR
- Occupational Therapist
- Pearland, TX
National Provider Identifier
1992030357
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 110636
- Practice address
- 2637 Lazy Bend St Ste 105
Pearland, TX 77581-1007 - Phone
- (713) 355-0623
- NPI assigned
- Oct 2, 2009
- 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 | 110636 | TX | Primary |
Addresses
Primary practice location
2637 Lazy Bend St Ste 105
Pearland, TX 77581-1007
Mailing address
2637 Lazy Bend Street Suite 105
Pearland, TX 77581
Phone (713) 355-0623
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 |
|---|---|---|---|
| 110636 | TX | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Learning Repertoire, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Developmentally Disabled Services Day Training Agency
- Pearland, TX
- NPI 1942434154
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1254441600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1254441600000",
"number": "1992030357",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2637 LAZY BEND STREET SUITE 105",
"city": "PEARLAND",
"state": "TX",
"postal_code": "77581",
"telephone_number": "713-355-0623"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2637 LAZY BEND ST STE 105",
"city": "PEARLAND",
"state": "TX",
"postal_code": "775811007",
"telephone_number": "713-355-0623"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGONER",
"first_name": "KRISTIE",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-10-02",
"last_updated": "2009-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TX",
"license": "110636",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pearland, TX
- Broderick Charles Wade
- Cody Ryan Wade, ATC
- Nanette Lynn Waegner, MOTR
- Gavin Neal Wagenheim, M.D.
- Taylor Wagner, CPHT
- Loice Muhonja Wakhu
- Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-7361)
- Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-3510)
- Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-3572)
- Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-0872)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.