Active NPI
Kelly Ann Chansky, OTR
- Occupational Therapist
- Kenosha, WI
National Provider Identifier
1114065422
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 3534-026
- Practice address
- 4103 60TH St
Kenosha, WI 53144-2509 - Phone
- (262) 652-1111
- Fax
- (262) 652-1124
- NPI assigned
- Feb 1, 2007
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 3534-026 | WI | Primary |
Addresses
Primary practice location
4103 60TH St
Kenosha, WI 53144-2509
Mailing address
4103 60TH St
Kenosha, WI 53144-2509
Phone (262) 652-1111
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 41040200 | Medicaid | WI |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3534-026 | WI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170288000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377043200000",
"number": "1114065422",
"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": {
"last_name": "CHANSKY",
"first_name": "KELLY",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-01",
"last_updated": "2013-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WI",
"license": "3534-026",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "41040200",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kenosha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 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.