Equimotion, Inc

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

15790-131 Issued in WI

Legal business name

EQUIMOTION, INC

Practice address

10750 Gage LN
Soldiers Grove, WI 54655-8564

Phone

(608) 632-4459

Fax

(608) 638-7429

NPI assigned

Aug 29, 2013

Organization subpart

No

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

Authorized official

Name

Katherine E Burke, SAC

Title

Owner

Phone

(608) 632-4459

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1377734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377734400000",
    "number": "1033543798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10750 GAGE LN",
            "city": "SOLDIERS GROVE",
            "state": "WI",
            "postal_code": "546558564",
            "telephone_number": "608-632-4459",
            "fax_number": "608-638-7429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10750 GAGE LN",
            "city": "SOLDIERS GROVE",
            "state": "WI",
            "postal_code": "546558564",
            "telephone_number": "608-632-4459",
            "fax_number": "608-638-7429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EQUIMOTION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-29",
        "last_updated": "2013-08-29",
        "status": "A",
        "authorized_official_last_name": "BURKE",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "608-632-4459",
        "authorized_official_credential": "SAC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "WI",
            "license": "15790-131",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821362831",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amy Lynn Byl, RN
• Joel Charles, M.D., M.P.H.
• Timothy J Devitt, M.D.
• Stacey Drew-Regan, DPT
• Tracy L Eick, PTA
• Rita Ann Fortney, RDH, RN
• Jordan Lee Gordon
• Shari M Graham Curry, COTA
• Ashley Lynne Hagen, MS, ATC, LAT
• Sue Ellen Johnson

• Mental Health Clinic/Center (Including Community Mental Health Center) in Soldiers Grove, WI
• Providers in Soldiers Grove, WI by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2013; 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.