NPI Code Detail JSON Logo

1003676628 NPI number — KAITLIN MEGAN VARGO COTA/L

NPI Number: 1003676628
Health Care Provider/Practitioner: KAITLIN MEGAN VARGO COTA/L

Information about “1003676628” NPI (KAITLIN MEGAN VARGO COTA/L) exists in 1003676628 in HTML format HTML  |  1003676628 in plain Text format TXT  |  1003676628 in PDF (Portable Document Format) PDF  |  1003676628 in an XML format XML  formats.

NPI Number : 1003676628 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1003676628",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "VARGO",
    "FirstName": "KAITLIN",
    "MiddleName": "MEGAN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "COTA/L",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "KIEWICZ",
    "OtherFirstName": "KAITLIN",
    "OtherMiddleName": "MEGAN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "COTA/L",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "48722 SUGARBUSH RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHESTERFIELD",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48047-3313",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "34901 DIVISION RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RICHMOND",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48062-1559",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "586-727-7562",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/20/2024",
    "LastUpdateDate": "03/20/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "224Z00000X",
        "TaxonomyName": "Occupational Therapy Assistant",
        "LicenseNumber": "5202007993",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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