Active NPI
Kelsey Kultgen
- Occupational Therapy Assistant
- West Bend, WI
National Provider Identifier
1144867771
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 5651
- Practice address
- 5595 County Road Z
West Bend, WI 53095-9224 - Phone
- (262) 306-2100
- NPI assigned
- Dec 2, 2019
- 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 Therapy Assistant | 224Z00000X | 5651 | WI | Primary |
Addresses
Primary practice location
5595 County Road Z
West Bend, WI 53095-9224
Mailing address
3741 River Lane Rd
Port Washington, WI 53074-9786
Phone (262) 305-2484
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 |
|---|---|---|---|
| 5651 | WI | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1575244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1575244800000",
"number": "1144867771",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3741 RIVER LANE RD",
"city": "PORT WASHINGTON",
"state": "WI",
"postal_code": "530749786",
"telephone_number": "262-305-2484"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5595 COUNTY ROAD Z",
"city": "WEST BEND",
"state": "WI",
"postal_code": "530959224",
"telephone_number": "262-306-2100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KULTGEN",
"first_name": "KELSEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-12-02",
"last_updated": "2019-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "WI",
"license": "5651",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Bend, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.