Good Shepherd Home, LTD

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

2659 Issued in WI

Legal business name

GOOD SHEPHERD HOME, LTD

Doing business as

Good Shepherd Rehabilitation Agency

Practice address

958 Foote Street
Seymour, WI 54165

Phone

(920) 833-7796

Fax

(920) 833-2220

NPI assigned

Mar 8, 2006

Organization subpart

No

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

Authorized official

Name

Deborah A Captain, RN NHA

Title

Executive Director

Phone

(920) 833-6856

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Good Shepherd Rehabilitation Agency Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Outpatient physical therapy / speech pathology certification: CCN 526540

Legal name

GOOD SHEPHERD REHABILITATION AGENCY

Certification status

Active

Provider type (POS)

Outpatient physical therapy / speech pathology

Participating since

Nov 12, 1992

Last certification

Aug 5, 2024

Ownership / control type

Voluntary Non-Profit Church

Facility address

958 Foote St
Seymour, WI 54165

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

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326326400000",
    "number": "1114995164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "958 FOOTE STREET",
            "city": "SEYMOUR",
            "state": "WI",
            "postal_code": "54165",
            "telephone_number": "920-833-7796",
            "fax_number": "920-833-2220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "958 FOOTE STREET",
            "city": "SEYMOUR",
            "state": "WI",
            "postal_code": "54165",
            "telephone_number": "920-833-7796",
            "fax_number": "920-833-2220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SHEPHERD HOME, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-08",
        "last_updated": "2012-01-12",
        "status": "A",
        "authorized_official_last_name": "CAPTAIN",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "920-833-6856",
        "authorized_official_credential": "RN NHA"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "2659",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "WI",
            "license": "2659",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "WI",
            "license": "2659",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41814400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Good Shepherd Rehabilitation Agency",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Denise M Ellis, LAT
• Dawn Marie Forcey, PTA
• Jeannine Marie Fortin, MD
• General Dentistry of Seymour Inc
• Heidi Louisa Gillis, PTA
• Good Shepherd Home, LTD
• Malina Herber, APNP
• Daria Lillian Heyn, O.T.R.
• Donald Joseph Hoff Jr., DDS
• Alissa A Huff

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.