Active NPI
Amanda M Walesh, COTA, CLT
- Occupational Therapy Assistant
- Sheboygan, WI
National Provider Identifier
1235653163
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 5310-27
- Practice address
- 2629 N 7TH St
Sheboygan, WI 53083-4932 - Phone
- (920) 551-5550
- NPI assigned
- Aug 2, 2017
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 5310 | WI | |
| Occupational Therapy Assistant | 224Z00000X | 5310-27 | WI | Primary |
Addresses
Primary practice location
2629 N 7TH St
Sheboygan, WI 53083-4932
Mailing address
2121 Illinois Ave
New Holstein, WI 53061-1210
Phone (920) 579-0879
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 |
|---|---|---|---|
| 5310-27 | WI | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1501632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1501632000000",
"number": "1235653163",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2121 ILLINOIS AVE",
"city": "NEW HOLSTEIN",
"state": "WI",
"postal_code": "530611210",
"telephone_number": "920-579-0879"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2629 N 7TH ST",
"city": "SHEBOYGAN",
"state": "WI",
"postal_code": "530834932",
"telephone_number": "920-551-5550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALESH",
"first_name": "AMANDA",
"middle_name": "M",
"credential": "COTA, CLT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-08-02",
"last_updated": "2017-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "WI",
"license": "5310",
"primary": false
},
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "WI",
"license": "5310-27",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sheboygan, WI
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- Walgreen Co (Walgreens #12020)
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- Walgreen Co (Walgreens #06097)
- Philip H Walker, MD
- Wall & Hamilton Optometrists SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.