Active NPI
Jenna Kristine Keller
- Occupational Therapist
- Shawano, WI
National Provider Identifier
1124772355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 7166-26
- Practice address
- 100 County Road B
Shawano, WI 54166-7072 - Phone
- (715) 526-7370
- NPI assigned
- Feb 7, 2022
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 7166-26 | WI | Primary |
Addresses
Primary practice location
100 County Road B
Shawano, WI 54166-7072
Mailing address
N4640 Rexford Rd
Shiocton, WI 54170-8816
Phone (920) 585-5877
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7166-26 | Other | WI | WISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES |
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 |
|---|---|---|---|
| 7166-26 | WI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1644192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1644192000000",
"number": "1124772355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "N4640 REXFORD RD",
"city": "SHIOCTON",
"state": "WI",
"postal_code": "541708816",
"telephone_number": "920-585-5877"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 COUNTY ROAD B",
"city": "SHAWANO",
"state": "WI",
"postal_code": "541667072",
"telephone_number": "715-526-7370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLER",
"first_name": "JENNA",
"middle_name": "KRISTINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-02-07",
"last_updated": "2022-02-07",
"certification_date": "2022-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WI",
"license": "7166-26",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES",
"identifier": "7166-26",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shawano, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 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.