Active NPI
Cresta Elizabeth Nutter, C.T.R.S.
- Recreation Therapist
- Oconomowoc, WI
National Provider Identifier
1073539649
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Recreation Therapist
- License
- 53913
- Practice address
- W274 Hillendale Dr
Oconomowoc, WI 53066-5528 - Phone
- (262) 567-4865
- NPI assigned
- Jul 15, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | 53913 | WI | Primary |
Addresses
Primary practice location
W274 Hillendale Dr
Oconomowoc, WI 53066-5528
Mailing address
W274 Hillendale Dr
Oconomowoc, WI 53066-5528
Phone (262) 567-4865
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53913 | WI | MD | Recreation Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1073539649",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "W274 HILLENDALE DR",
"city": "OCONOMOWOC",
"state": "WI",
"postal_code": "530665528",
"telephone_number": "262-567-4865"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "W274 HILLENDALE DR",
"city": "OCONOMOWOC",
"state": "WI",
"postal_code": "530665528",
"telephone_number": "262-567-4865"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NUTTER",
"first_name": "CRESTA",
"middle_name": "ELIZABETH",
"credential": "C.T.R.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225800000X",
"taxonomy_group": "",
"desc": "Recreation Therapist",
"state": "WI",
"license": "53913",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oconomowoc, WI
Sources for this page
- 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.