Active NPI
Kristin Clevenstine, OTR
- Occupational Therapist
- Oconomowoc, WI
National Provider Identifier
1255572459
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- Practice address
- 2195 N Summit Village Way
Oconomowoc, WI 53066-8675 - Phone
- (262) 560-2400
- NPI assigned
- Mar 18, 2009
- Last updated
- Oct 24, 2011
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | Primary |
Addresses
Primary practice location
2195 N Summit Village Way
Oconomowoc, WI 53066-8675
Mailing address
13500 W Stratford Dr
New Berlin, WI 53151-6215
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40871100 | Medicaid | WI |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3543 | WI | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1237334400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319414400000",
"number": "1255572459",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13500 W STRATFORD DR",
"city": "NEW BERLIN",
"state": "WI",
"postal_code": "531516215"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2195 N SUMMIT VILLAGE WAY",
"city": "OCONOMOWOC",
"state": "WI",
"postal_code": "530668675",
"telephone_number": "262-560-2400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEVENSTINE",
"first_name": "KRISTIN",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-03-18",
"last_updated": "2011-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40871100",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oconomowoc, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.