Paul Joseph Dery, C.O.T.A.

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

871-027 Issued in WI

Practice address

2512 New Pine Dr
Altoona, WI 54720-1378

Phone

(715) 833-0400

Fax

(715) 833-0397

NPI assigned

May 16, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

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": "1179273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003023433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2149 15TH ST",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547032656",
            "telephone_number": "715-839-9127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2512 NEW PINE DR",
            "city": "ALTOONA",
            "state": "WI",
            "postal_code": "547201378",
            "telephone_number": "715-833-0400",
            "fax_number": "715-833-0397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERY",
        "first_name": "PAUL",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "credential": "C.O.T.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "WI",
            "license": "871-027",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40880800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapy Assistant in Altoona, WI
• Providers in Altoona, WI by specialty
• Occupational Therapy Assistant in Wisconsin

• 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.