Active NPI
Colleen Wismer
- Occupational Therapist
- Philadelphia, PA
National Provider Identifier
1245821677
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OC017396
- Practice address
- 263 Greenough St
Philadelphia, PA 19127-1116 - Phone
- (267) 566-0529
- NPI assigned
- Jan 28, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 | OC017396 | PA | Primary |
Addresses
Primary practice location
263 Greenough St
Philadelphia, PA 19127-1116
Mailing address
263 Greenough St
Philadelphia, PA 19127-1116
Phone (267) 566-0529
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 |
|---|---|---|---|
| OC017396 | PA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1611792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611792000000",
"number": "1245821677",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "263 GREENOUGH ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191271116",
"telephone_number": "267-566-0529"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "263 GREENOUGH ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191271116",
"telephone_number": "267-566-0529"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISMER",
"first_name": "COLLEEN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-01-28",
"last_updated": "2021-01-28",
"certification_date": "2021-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "PA",
"license": "OC017396",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 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.