Active NPI
Jacob Peloquin, OT
- Occupational Therapist
- Black River Falls, WI
National Provider Identifier
1275777575
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 4416
- Practice address
- 1311 Tyler St
Black River Falls, WI 54615-1564 - Phone
- (608) 498-6021
- NPI assigned
- Apr 30, 2009
- Last updated
- Aug 28, 2023
- Sex
- Male
- 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 | 4416 | WI | Primary |
Addresses
Primary practice location
1311 Tyler St
Black River Falls, WI 54615-1564
Mailing address
1311 Tyler St
Black River Falls, WI 54615-1564
Phone (608) 498-6021
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 |
|---|---|---|---|
| 4416 | WI | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| NSH Marshfield LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Marshfield Health Services
- Skilled Nursing Facility
- Marshfield, WI
- NPI 1295378123
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1241049600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693180800000",
"number": "1275777575",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1311 TYLER ST",
"city": "BLACK RIVER FALLS",
"state": "WI",
"postal_code": "546151564",
"telephone_number": "608-498-6021"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1311 TYLER ST",
"city": "BLACK RIVER FALLS",
"state": "WI",
"postal_code": "546151564",
"telephone_number": "608-498-6021"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PELOQUIN",
"first_name": "JACOB",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-04-30",
"last_updated": "2023-08-28",
"certification_date": "2023-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WI",
"license": "4416",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Black River Falls, WI
- Cosmas Okpalaebube, PHARMACIST
- Jill Oostdyk, PTA
- Tina Louise Opelt, RN MS CS FNP
- Jerry V Overman, D.D.S.
- Suchita Hardik Patel
- Brenna Ann Peters, DNP
- Danielle Louise Peterson, DDS
- PFHN, LLC (Family Heritage Nursing & Rehabilitation Center)
- Pineview Nursing Home (Pineview Care Center)
- John Pleugers, M.A. LPC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.