Active NPI
Phillip G Mitchell, OT
- Occupational Therapist
- Madison, WI
National Provider Identifier
1114786142
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 6627-26
- Practice address
- 202 S Park St
Madison, WI 53715-1507 - Phone
- (608) 417-8250
- Fax
- (608) 417-8251
- NPI assigned
- Mar 13, 2024
- Sex
- Male
- 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 Therapist | 225X00000X | 6627-26 | WI | Primary |
Addresses
Primary practice location
202 S Park St
Madison, WI 53715-1507
Mailing address
202 S Park St
Madison, WI 53715-1507
Phone (608) 417-8250
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 |
|---|---|---|---|
| 6627-26 | WI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1710288000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1710288000000",
"number": "1114786142",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "202 S PARK ST",
"city": "MADISON",
"state": "WI",
"postal_code": "537151507",
"telephone_number": "608-417-8250",
"fax_number": "608-417-8251"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "202 S PARK ST",
"city": "MADISON",
"state": "WI",
"postal_code": "537151507",
"telephone_number": "608-417-8250",
"fax_number": "608-417-8251"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITCHELL",
"first_name": "PHILLIP",
"middle_name": "G",
"credential": "OT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-03-13",
"last_updated": "2024-03-13",
"certification_date": "2024-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WI",
"license": "6627-26",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.