NPIMap

Individual provider Active NPI

Jennifer M Konieczny, OTR

  • Occupational Therapist
  • Wisconsin Rapids, WI
National Provider Identifier
1154440006
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
3613-01 Issued in WI
Practice address
3541 Plover Rd
Wisconsin Rapids, WI 54494-2155
Phone
(715) 423-5423
Fax
(715) 423-1532
NPI assigned
Mar 29, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 3613-01 WI Primary

Addresses

Primary practice location

3541 Plover Rd
Wisconsin Rapids, WI 54494-2155

Mailing address

3541 Plover Rd
Wisconsin Rapids, WI 54494-2155
Phone (715) 423-5423

Other identifiers 1

IdentifierTypeStateIssuer
40845100MedicaidWI

Other names 1

  • Jennifer M Beck Former name

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
3613-01WIMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Taylor County Past Accepting new patients
County of Wood Past Accepting new patients
Therapies Plus LLC Occupational Therapist Past Accepting new patients
Clark County Past Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1154440006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3541 PLOVER RD",
            "city": "WISCONSIN RAPIDS",
            "state": "WI",
            "postal_code": "544942155",
            "telephone_number": "715-423-5423",
            "fax_number": "715-423-1532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3541 PLOVER RD",
            "city": "WISCONSIN RAPIDS",
            "state": "WI",
            "postal_code": "544942155",
            "telephone_number": "715-423-5423",
            "fax_number": "715-423-1532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONIECZNY",
        "first_name": "JENNIFER",
        "middle_name": "M",
        "credential": "OTR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WI",
            "license": "3613-01",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40845100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "BECK",
            "middle_name": "M",
            "credential": "OTR",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Wisconsin Rapids, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.