Carrie M Kies, OTR
Individual provider Active NPI Occupational Therapist · Appleton, WI
NPI 1164568150 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1164568150
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 2705 (WI)
- Practice address
- 3305 N Ballard Rd Ste C
Appleton, WI 54911-9001 - Phone
- (920) 735-9234
- NPI assigned
- Jan 29, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 27
Medicare Care Compare profile
- Specialty
- Occupational Therapist in Private Practice
- Education
- Other, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Aegis Group Practice LLC
Practice addresses (Care Compare)
825 Cobblestone LN
Kimberly, WI 54136-2116
Phone (800) 444-6845
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130606000197 | WI | Practitioner - Occupational Therapist in Private Practice | 4981842739 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2705 | WI | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aegis Group Practice LLC | Occupational Therapist | Current |
Accepting new patients |
| Aegis Group Practice LLC | Occupational Therapist | Current | Accepting new patients |
| Aegis Group Practice LLC | Occupational Therapist | Current |
Accepting new patients |
| Valley-Bay Therapy Inc. | Occupational Therapist | Past |
Accepting new patients |
Locations
4933 Old Greenwood Rd
Fort Smith, AR 72903
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 2705 | WI | Yes |
Addresses
Primary practice location
3305 N Ballard Rd Ste C
Appleton, WI 54911-9001
Mailing address
5193 High Pointe Dr
Winneconne, WI 54986-8642
Phone (920) 582-4465
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40793300 | Medicaid | WI |
NPI Registry JSON
{
"created_epoch": "1170028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1164568150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5193 HIGH POINTE DR",
"city": "WINNECONNE",
"state": "WI",
"postal_code": "549868642",
"telephone_number": "920-582-4465"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3305 N BALLARD RD STE C",
"city": "APPLETON",
"state": "WI",
"postal_code": "549119001",
"telephone_number": "920-735-9234"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIES",
"first_name": "CARRIE",
"middle_name": "M",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-29",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WI",
"license": "2705",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40793300",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Appleton, WI
- Karen A Kewley
- Musa Khan
- Saba R Khan
- Korbin Daniel Kierstead
- Chloe J Kierszh
- Brian Kiesnowski
- Kiger Steffes Chiropractic S.C.
- Brenden Thomas Kiger
- Sarah Elizabeth Kiger
- Karly Kilgas
All providers in Appleton, WI · Occupational Therapist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.