Active NPI
Jamie Witkowski
- Occupational Therapist
- Bloomer, WI
National Provider Identifier
1205046513
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 3021-026
- Practice address
- 1402 Main St
Bloomer, WI 54724-1637 - Phone
- (715) 568-4669
- NPI assigned
- May 23, 2007
- 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 Therapist | 225X00000X | 3021-026 | WI | Primary |
Addresses
Primary practice location
1402 Main St
Bloomer, WI 54724-1637
Mailing address
13249 38TH Ave
Chippewa Falls, WI 54729-7339
Phone (715) 720-7830
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40804300 | 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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3021-026 | WI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1205046513",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13249 38TH AVE",
"city": "CHIPPEWA FALLS",
"state": "WI",
"postal_code": "547297339",
"telephone_number": "715-720-7830"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1402 MAIN ST",
"city": "BLOOMER",
"state": "WI",
"postal_code": "547241637",
"telephone_number": "715-568-4669"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WITKOWSKI",
"first_name": "JAMIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WI",
"license": "3021-026",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40804300",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bloomer, 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.