Nicole Marie Chisholm, OTR/L

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

6936-26 Issued in WI

Practice address

2705 Enloe St
Hudson, WI 54016-8173

Phone

(715) 690-2600

Fax

(715) 381-8131

NPI assigned

Mar 16, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Speech & Therapy Services, LLC

  • Speech-Language Pathologist
  • Andover, MN
  • NPI 1235285966
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642464000000",
    "number": "1013592542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2705 ENLOE ST",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540168173",
            "telephone_number": "715-690-2600",
            "fax_number": "715-381-8131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2705 ENLOE ST",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540168173",
            "telephone_number": "715-690-2600",
            "fax_number": "715-381-8131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHISHOLM",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-16",
        "last_updated": "2022-01-18",
        "certification_date": "2022-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "WI",
            "license": "6936-26",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey S Cavaness, MD
• Haley Marie Cernohous
• Rachel L Chaltry, DO
• Olivea Chambers
• Chiro One Wellness Center of Hudson LLC
• Choicepoints LLC
• Garth Neil Christenson, O.D.
• Griffin Christenson, OD
• Christian Community Home of Hudson, Inc
• Christopher Buege DDS Dba Grandview Dental

• Pediatric Occupational Therapist in Hudson, WI
• Providers in Hudson, WI by specialty
• Pediatric Occupational Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.