Active NPI
Maria Kohlwey, LAT
- Athletic Trainer
- Pewaukee, WI
National Provider Identifier
1215296249
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 1038-39
- Practice address
- 2835 N Grandview Blvd
Ste. 100
Pewaukee, WI 53072-5546 - Phone
- (262) 574-5185
- NPI assigned
- May 11, 2012
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 1038-39 | WI | Primary |
Addresses
Primary practice location
2835 N Grandview Blvd
Ste. 100
Pewaukee, WI 53072-5546
Mailing address
790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2223
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 |
|---|---|---|---|
| 1038-39 | WI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1336694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1425254400000",
"number": "1215296249",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "790 REMINGTON BLVD",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604404909",
"telephone_number": "630-296-2223"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2835 N GRANDVIEW BLVD",
"address_2": "STE. 100",
"city": "PEWAUKEE",
"state": "WI",
"postal_code": "530725546",
"telephone_number": "262-574-5185"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOHLWEY",
"first_name": "MARIA",
"credential": "LAT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-05-11",
"last_updated": "2015-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WI",
"license": "1038-39",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pewaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.