Great Lakes Healthcare, Inc.

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

Legal business name

GREAT LAKES HEALTHCARE, INC.

Doing business as

Preceptor Therapy

Practice address

W175N11117 Stonewood Dr Ste 100
Germantown, WI 53022-6505

Phone

(208) 401-1369

NPI assigned

May 30, 2019

Organization subpart

No

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

Authorized official

Name

Lee Johnson

Title

Treasurer

Phone

(208) 401-1369

Specialties & licenses 3

Addresses

Other names 1

• Preceptor Therapy Doing business as

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

{
    "created_epoch": "1559174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615939200000",
    "number": "1184282618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W175N11117 STONEWOOD DR STE 100",
            "city": "GERMANTOWN",
            "state": "WI",
            "postal_code": "530226505",
            "telephone_number": "262-293-3951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W175N11117 STONEWOOD DR STE 100",
            "city": "GERMANTOWN",
            "state": "WI",
            "postal_code": "530226505",
            "telephone_number": "208-401-1369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-30",
        "last_updated": "2021-03-17",
        "certification_date": "2021-03-17",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "LEE",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "208-401-1369"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Preceptor Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Laura L Goba, APSW
• Brandon Goesch
• Timothy F Goggins, M.D.
• Patricia Ann Gottsacker, P.T., C.PED.
• Great Lakes Dental, LLC
• Great Lakes Healthcare, Inc. (Preceptor Home Health)
• Great Lakes Healthcare, Inc. (Preceptor Hospice)
• Kaitlin Rose Grigoryev
• Marisa Groshek, DPT
• Erin Therese Grueneberg, DNP

• Occupational Therapist in Germantown, WI
• Providers in Germantown, WI by specialty
• Occupational Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2021; 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.