Active NPI
Melissa Rose Shea, COTA
- Occupational Therapy Assistant
- Byron, WI
National Provider Identifier
1104171305
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 4824-27
- Practice address
- N3015 Hickory Rd
Byron, WI 53006-1126 - Phone
- (920) 933-4344
- Fax
- (920) 482-1273
- NPI assigned
- Jul 13, 2012
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 4824-27 | WI | Primary |
Addresses
Primary practice location
N3015 Hickory Rd
Byron, WI 53006-1126
Mailing address
414 Brookridge St
Allouez, WI 54301-2132
Phone (920) 471-6198
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 |
|---|---|---|---|
| 4824-27 | WI | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1342137600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1342137600000",
"number": "1104171305",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "414 BROOKRIDGE ST",
"city": "ALLOUEZ",
"state": "WI",
"postal_code": "543012132",
"telephone_number": "920-471-6198"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "N3015 HICKORY RD",
"city": "BYRON",
"state": "WI",
"postal_code": "530061126",
"telephone_number": "920-933-4344",
"fax_number": "920-482-1273"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEA",
"first_name": "MELISSA",
"middle_name": "ROSE",
"name_prefix": "Mrs.",
"credential": "COTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-07-13",
"last_updated": "2012-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "WI",
"license": "4824-27",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Byron, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.