Wisconsin Center for Myofascial Release, SC

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

3534-026 Issued in WI

Legal business name

WISCONSIN CENTER FOR MYOFASCIAL RELEASE, SC

Practice address

4103 60TH St
Kenosha, WI 53144-2509

Phone

(262) 652-1111

Fax

(262) 652-1124

NPI assigned

Apr 18, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Priscilla Linda Horswell

Title

Office Manager

Phone

(262) 652-1111

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jena Leigh Clark, OTR

  • Occupational Therapist
  • Brookfield, WI
  • NPI 1184697260
  NPD (past)
• Jane E Meyers, OT

  • Occupational Therapist
  • Kenosha, WI
  • NPI 1053574285
  NPD (past)
• Carol Margaret Michels, OTR

  • Specialist
  • Kenosha, WI
  • NPI 1134360084
  NPD (past)

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377475200000",
    "number": "1104042902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4103 60TH ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531442509",
            "telephone_number": "262-652-1111",
            "fax_number": "262-652-1124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4103 60TH ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531442509",
            "telephone_number": "262-652-1111",
            "fax_number": "262-652-1124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISCONSIN CENTER FOR MYOFASCIAL RELEASE, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2013-08-26",
        "status": "A",
        "authorized_official_last_name": "HORSWELL",
        "authorized_official_first_name": "PRISCILLA",
        "authorized_official_middle_name": "LINDA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "262-652-1111",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "WI",
            "license": "3534-026",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41012800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa A Wingate, PSYD
• Leslie Eugene Winget III
• Mackenzie Winkler, FNP
• Kara Winslow, M.S., R.D., C.D.
• Amanda Winter, RN, RCS
• Wisconsin CVS Pharmacy LLC
• Wisconsin CVS Pharmacy LLC
• Wisconsin CVS Pharmacy LLC
• Wisconsin Dental Group, S.C.
• Wisconsin Foot & Ankle Center LLC

• All providers in Kenosha, WI
• Occupational Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 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.