Healthcare Provider Details
I. General information
NPI: 1255995080
Provider Name (Legal Business Name): CARL KAPPENHAGEN OT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 04/26/2019
Last Update Date: 05/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
4350 W 28TH ST
CLEVELAND OH
44109-4167
US
IV. Provider business mailing address
4350 W 28TH ST
CLEVELAND OH
44109-4167
US
V. Phone/Fax
- Phone: 216-356-2380
- Fax:
- Phone: 216-356-2380
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 251C00000X |
| Taxonomy | Developmentally Disabled Services Day Training Agency |
| License Number | |
| License Number State | NULL |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101Y00000X |
| Taxonomy | Counselor |
| License Number | |
| License Number State | NULL |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YM0800X |
| Taxonomy | Mental Health Counselor |
| License Number | |
| License Number State | NULL |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YP2500X |
| Taxonomy | Professional Counselor |
| License Number | |
| License Number State | NULL |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YS0200X |
| Taxonomy | School Counselor |
| License Number | |
| License Number State | NULL |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 372500000X |
| Taxonomy | Chore Provider |
| License Number | |
| License Number State | NULL |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 372600000X |
| Taxonomy | Adult Companion |
| License Number | |
| License Number State | NULL |
| # 8 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 373H00000X |
| Taxonomy | Day Training/Habilitation Specialist |
| License Number | |
| License Number State | NULL |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 374U00000X |
| Taxonomy | Home Health Aide |
| License Number | |
| License Number State | NULL |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 376J00000X |
| Taxonomy | Homemaker |
| License Number | |
| License Number State | NULL |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 133NN1002X |
| Taxonomy | Nutrition Education Nutritionist |
| License Number | |
| License Number State | NULL |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 224Z00000X |
| Taxonomy | Occupational Therapy Assistant |
| License Number | |
| License Number State | NULL |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 225800000X |
| Taxonomy | Recreation Therapist |
| License Number | |
| License Number State | NULL |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 253Z00000X |
| Taxonomy | In Home Supportive Care Agency |
| License Number | |
| License Number State | NULL |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
