Korine Ann Labodda, OTR
Individual provider Active NPI Occupational Therapist · Wind Lake, WI
NPI 1124270301 · NPPES record last updated Oct 19, 2008
Key facts
- NPI
- 1124270301
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 1492-026 (WI)
- Practice address
- 8303 Virginia Cir
Wind Lake, WI 53185-1384 - Phone
- (262) 895-6766
- NPI assigned
- Oct 19, 2008
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250728002639 | WI | Practitioner - Occupational Therapist in Private Practice | 2466969142 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1492 | WI | MD | Clinical Child & Adolescent Psychologist |
| 1492-026 | WI | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prohealth Medical Group Inc. | Current |
Accepting new patients | |
| Prohealth Medical Group Inc | Current |
Accepting new patients |
Locations
240 Maple Ave
Mukwonago, WI 53149
Phone (262) 928-1900
808 Cornerstone Ct
Waterford, WI 53185
Phone (262) 928-1977
725 American Ave
Waukesha, WI 53188
Phone (262) 544-2011
N17W24100 Riverwood Dr
Waukesha, WI 53188
Phone (262) 820-3093
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 1492-026 | WI | Yes |
Addresses
Primary practice location
8303 Virginia Cir
Wind Lake, WI 53185-1384
Mailing address
8303 Virginia Cir
Wind Lake, WI 53185-1384
Phone (262) 895-6766
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40691400 | Medicaid | WI |
Other providers in Wind Lake, WI
- Erik R Burtraw
- Leah C. Clemence
- Melissa Mary Fitzgerald
- Makenzi Gordon
- Denise L Holterman
- Anne Marie Leidel
- Debra Ann Pokrzywinski
- Gretchen Anne Rothfelder
- Tracy Anne Scholfield
- Jill Lynn Sieren
All providers in Wind Lake, WI · Occupational Therapist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 19, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.