Michelle Beth
Individual provider Active NPI Pediatric Occupational Therapist · Kenosha, WI
NPI 1093988313 · NPPES record last updated Apr 8, 2008
Key facts
- NPI
- 1093988313
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Occupational Therapist 225XP0200X
- License
- 2029-026 (WI)
- Practice address
- 1218 79TH St
Kenosha, WI 53143-6111 - Phone
- (262) 658-9500
- Fax
- (262) 658-9621
- NPI assigned
- Apr 8, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2029-026 | WI | MD | Pediatric Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kenosha Achievement Center | Pediatrics | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 2029-026 | WI | Yes |
Addresses
Primary practice location
1218 79TH St
Kenosha, WI 53143-6111
Mailing address
1218 79TH St
Kenosha, WI 53143-6111
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40727700 | Medicaid | WI |
Other providers in Kenosha, WI
- Mary Susan Bernardy
- Natalie R. L Berryman
- Best Practices Inpatient Care,LTD.
- Linda Bestor
- Madeline Marie Beth
- Connie Lee Bevry
- Rebecca Rose Bewley
- Bonnie K Beyer
- Beyond ABA, LLC
- Elizabeth Bianchi Knod
All providers in Kenosha, WI · Pediatric Occupational Therapist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 8, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.