Active NPI
Elise Marie Wagner
- Occupational Therapist
- Bristol, IL
National Provider Identifier
1144710997
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 056009322
- Practice address
- 23 Hunt St
Bristol, IL 60512-2003 - Phone
- (630) 553-4383
- NPI assigned
- May 17, 2018
- Last updated
- May 17, 2018
- 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 | 056009322 | IL | Primary |
Addresses
Primary practice location
23 Hunt St
Bristol, IL 60512-2003
Mailing address
321 Spring St
Batavia, IL 60510-2321
Phone (815) 931-8524
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 |
|---|---|---|---|
| 056009322 | IL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1526515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1526515200000",
"number": "1144710997",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "321 SPRING ST",
"city": "BATAVIA",
"state": "IL",
"postal_code": "605102321",
"telephone_number": "815-931-8524"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23 HUNT ST",
"city": "BRISTOL",
"state": "IL",
"postal_code": "605122003",
"telephone_number": "630-553-4383"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "ELISE",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-05-17",
"last_updated": "2018-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IL",
"license": "056009322",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bristol, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.