Nichole M Elmendorf, OTR

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

2461 Issued in WI

Practice address

1125 N 13TH St
Sheboygan, WI 53081-3281

Phone

(920) 803-1617

Fax

(920) 803-1622

NPI assigned

Feb 10, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Progressive Beginnings, LLC

  • Rehabilitation Clinic/Center
  • Sheboygan, WI
  • NPI 1598886152
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1202601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665360000000",
    "number": "1255519443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 N 13TH ST",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530813281",
            "telephone_number": "920-803-1617",
            "fax_number": "920-803-1622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 N 13TH ST",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530813281",
            "telephone_number": "920-803-1617",
            "fax_number": "920-803-1622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELMENDORF",
        "first_name": "NICHOLE",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "OTR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-10",
        "last_updated": "2022-10-10",
        "certification_date": "2022-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "WI",
            "license": "2461",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40806400",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41813000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brenda Edmunds, APNP
• Kay Eilert, RDH
• Laura Eisberner
• Elite Chiropractic Sheboygan SC (Wisconsin Spine Center)
• John L Elmendorf III, OTR/L
• Daniel Elmes, DPM
• Embracing Cares LLC
• Carol Emerick, LPN
• Kelley Michelle Encinas, RD
• Linden J Engelsma, PA-C

• Pediatric Occupational Therapist in Sheboygan, WI
• Providers in Sheboygan, WI by specialty
• Pediatric Occupational Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.