Active NPI
Mandy M Ploederl, COTA
- Occupational Therapy Assistant
- Manitowoc, WI
National Provider Identifier
1174790398
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 4582-027
- Practice address
- 960 S Rapids Rd
Manitowoc, WI 54220-4146 - Phone
- (920) 684-1144
- NPI assigned
- May 15, 2008
- 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 | 4582-027 | WI | Primary |
Addresses
Primary practice location
960 S Rapids Rd
Manitowoc, WI 54220-4146
Mailing address
960 S Rapids Rd
Manitowoc, WI 54220-4146
Phone (920) 684-1144
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 41058900 | Medicaid | WI |
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 |
|---|---|---|---|
| 4582-027 | WI | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210809600000",
"number": "1174790398",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "960 S RAPIDS RD",
"city": "MANITOWOC",
"state": "WI",
"postal_code": "542204146",
"telephone_number": "920-684-1144"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "960 S RAPIDS RD",
"city": "MANITOWOC",
"state": "WI",
"postal_code": "542204146",
"telephone_number": "920-684-1144"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PLOEDERL",
"first_name": "MANDY",
"middle_name": "M",
"credential": "COTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-05-15",
"last_updated": "2008-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "WI",
"license": "4582-027",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "41058900",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Manitowoc, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.