Corey Jean Bruce, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

5219-26 Issued in WI

Practice address

1451 Bluestem Blvd
Altoona, WI 54720

Phone

(715) 579-5621

NPI assigned

Oct 3, 2012

Last updated

Aug 3, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Corey Jean White Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Functions LLC

  • Pediatric Occupational Therapist
  • Altoona, WI
  • NPI 1376279828
  NPD Authorized official

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

{
    "created_epoch": "1349222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659484800000",
    "number": "1114279098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18200 51ST AVE",
            "city": "CHIPPEWA FALLS",
            "state": "WI",
            "postal_code": "547296838",
            "telephone_number": "715-579-5621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1451 BLUESTEM BLVD",
            "city": "ALTOONA",
            "state": "WI",
            "postal_code": "54720",
            "telephone_number": "715-579-5621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUCE",
        "first_name": "COREY",
        "middle_name": "JEAN",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-10-03",
        "last_updated": "2022-08-03",
        "certification_date": "2022-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WI",
            "license": "5219-26",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114279098",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COREY",
            "last_name": "WHITE",
            "middle_name": "JEAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Krishna V Brahmbhatt
• Patrick Lyndon Brauer, PA-C
• Jennifer Rae Brayton, PA, ATC, LAT
• Hazel Fern Brown
• Jens Brown, D.O.
• Susann Bruno
• Alexandra Burke, PA-C
• Adam Robert Burmeister, PA-C
• Mallory Rose Burmeister
• Amanda Lynn Busse, COTA

• Occupational Therapist in Altoona, WI
• Providers in Altoona, WI by specialty
• Occupational Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2022; 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.