Active NPI
Jennifer Radke, COTA
- Occupational Therapy Assistant
- Mayville, WI
National Provider Identifier
1194032383
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 4768
- Practice address
- 210 Mary St
Apt. 103
Mayville, WI 53050-1080 - Phone
- (715) 218-2113
- NPI assigned
- Sep 9, 2010
- 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 | 4768 | WI | Primary |
Addresses
Primary practice location
210 Mary St
Apt. 103
Mayville, WI 53050-1080
Mailing address
210 Mary St
Apt. 103
Mayville, WI 53050-1080
Phone (715) 218-2113
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 |
|---|---|---|---|
| 4768 | WI | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1283990400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375747200000",
"number": "1194032383",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 MARY ST",
"address_2": "APT. 103",
"city": "MAYVILLE",
"state": "WI",
"postal_code": "530501080",
"telephone_number": "715-218-2113"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 MARY ST",
"address_2": "APT. 103",
"city": "MAYVILLE",
"state": "WI",
"postal_code": "530501080",
"telephone_number": "715-218-2113"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RADKE",
"first_name": "JENNIFER",
"credential": "COTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-09-09",
"last_updated": "2013-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "WI",
"license": "4768",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mayville, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.