Active NPI
Kimberly M Wotruba-Oleson, P.T.
- Physical Therapist
- Peshtigo, WI
National Provider Identifier
1093965915
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 3646
- Practice address
- 620 Harper Ave
Peshtigo, WI 54157-1134 - Phone
- (715) 582-4148
- NPI assigned
- Sep 28, 2008
- Last updated
- Sep 28, 2008
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 3646 | WI | Primary |
Addresses
Primary practice location
620 Harper Ave
Peshtigo, WI 54157-1134
Mailing address
6422 Aspen Dr
Sobieski, WI 54171-9773
Phone (920) 822-5219
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 |
|---|---|---|---|
| 3646 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222560000000",
"number": "1093965915",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6422 ASPEN DR",
"city": "SOBIESKI",
"state": "WI",
"postal_code": "541719773",
"telephone_number": "920-822-5219"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "620 HARPER AVE",
"city": "PESHTIGO",
"state": "WI",
"postal_code": "541571134",
"telephone_number": "715-582-4148"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOTRUBA-OLESON",
"first_name": "KIMBERLY",
"middle_name": "M",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-09-28",
"last_updated": "2008-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "3646",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peshtigo, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.