Individual provider Active NPI

Marsha Jane Smits Goffard, OTR

  • Occupational Therapist
  • Green Bay, WI
National Provider Identifier
1255536124
Registry record updated Mar 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
1530-026 Issued in WI
Practice address
2801 S Webster Ave
Green Bay, WI 54301-2878
Phone
(920) 337-1122
Fax
(920) 337-1126
NPI assigned
Jun 19, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 1530-026 WI Primary

Addresses

Primary practice location

2801 S Webster Ave
Green Bay, WI 54301-2878

Mailing address

2154 William Francis CT
Green Bay, WI 54311-6352

Other identifiers 1

IdentifierTypeStateIssuer
4181-0300MedicaidWI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mgoffard22566@ewd.direct.hshs.org Direct

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

LicenseStateTypeSpecialty
1530-026WIMDOccupational Therapist

Interoperability endpoints

  • Direct secure messaging: mgoffard22566@ewd.direct.hshs.org

NPI Registry JSON

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

{
    "created_epoch": "1182211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647993600000",
    "number": "1255536124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2154 WILLIAM FRANCIS CT",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543116352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 S WEBSTER AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543012878",
            "telephone_number": "920-337-1122",
            "fax_number": "920-337-1126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOFFARD",
        "first_name": "MARSHA",
        "middle_name": "JANE SMITS",
        "credential": "OTR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-19",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WI",
            "license": "1530-026",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4181-0300",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mgoffard22566@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "835 S Van Buren St",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543013526",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.