Active NPI
Mary Ognenoff, OTR
- Occupational Therapist
- West Bend, WI
National Provider Identifier
1003965500
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 1760-026
- Practice address
- 3200 Pleasant Valley Rd
West Bend, WI 53095-9274 - Phone
- (262) 677-6805
- Fax
- (262) 677-6801
- NPI assigned
- Jan 10, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | 1760-026 | WI | Primary |
Addresses
Primary practice location
3200 Pleasant Valley Rd
West Bend, WI 53095-9274
Mailing address
151 N German St
Mayville, WI 53050-1311
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40814700 | Medicaid | WI |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1760-026 | WI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1003965500",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "151 N GERMAN ST",
"city": "MAYVILLE",
"state": "WI",
"postal_code": "530501311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3200 PLEASANT VALLEY RD",
"city": "WEST BEND",
"state": "WI",
"postal_code": "530959274",
"telephone_number": "262-677-6805",
"fax_number": "262-677-6801"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OGNENOFF",
"first_name": "MARY",
"credential": "OTR",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-10",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WI",
"license": "1760-026",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40814700",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Bend, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.