Active NPI
Nikita Fetter
- Occupational Therapist
- Beaver Dam, WI
National Provider Identifier
1124569694
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 8591-26
- Practice address
- 914 N Spring St
Beaver Dam, WI 53916-1752 - Phone
- (920) 382-7202
- NPI assigned
- Mar 16, 2017
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Occupational Therapist | 225X00000X | 8591-26 | WI | Primary |
Addresses
Primary practice location
914 N Spring St
Beaver Dam, WI 53916-1752
Mailing address
914 N Spring St
Beaver Dam, WI 53916-1752
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 |
|---|---|---|---|
| 8591-26 | WI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1489622400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721952000000",
"number": "1124569694",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "914 N SPRING ST",
"city": "BEAVER DAM",
"state": "WI",
"postal_code": "539161752"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "914 N SPRING ST",
"city": "BEAVER DAM",
"state": "WI",
"postal_code": "539161752",
"telephone_number": "920-382-7202"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FETTER",
"first_name": "NIKITA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-03-16",
"last_updated": "2024-07-26",
"certification_date": "2024-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WI",
"license": "8591-26",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaver Dam, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 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.