Active NPI
Meghan R Driessen, PTA
- Rehabilitation Practitioner
- New Holstein, WI
National Provider Identifier
1083990212
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- License
- 1783-019
- Practice address
- 1609 Coolidge St
New Holstein, WI 53061-1629 - Phone
- (920) 898-5627
- Fax
- (920) 898-1375
- NPI assigned
- Nov 2, 2011
- 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 |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | 1783-019 | WI | Primary |
Addresses
Primary practice location
1609 Coolidge St
New Holstein, WI 53061-1629
Mailing address
1013 Hennes CT
Kaukauna, WI 54130-2627
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 |
|---|---|---|---|
| 1783-019 | WI | MD | Rehabilitation Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1320192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370390400000",
"number": "1083990212",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1013 HENNES CT",
"city": "KAUKAUNA",
"state": "WI",
"postal_code": "541302627"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1609 COOLIDGE ST",
"city": "NEW HOLSTEIN",
"state": "WI",
"postal_code": "530611629",
"telephone_number": "920-898-5627",
"fax_number": "920-898-1375"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DRIESSEN",
"first_name": "MEGHAN",
"middle_name": "R",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-11-02",
"last_updated": "2013-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": "WI",
"license": "1783-019",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Holstein, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 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.