Active NPI
Tracy Willms, COTA
- Occupational Therapy Assistant
- Kenosha, WI
National Provider Identifier
1295948438
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 1233-027
- Practice address
- 8633 32ND Ave
Kenosha, WI 53142-5187 - Phone
- (262) 694-8800
- NPI assigned
- May 7, 2007
- 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 Therapy Assistant | 224Z00000X | 1233-027 | WI | Primary |
Addresses
Primary practice location
8633 32ND Ave
Kenosha, WI 53142-5187
Mailing address
10102 W 5 Mile Rd
Franksville, WI 53126-9704
Phone (262) 835-9377
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40825900 | 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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1233-027 | WI | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1295948438",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10102 W 5 MILE RD",
"city": "FRANKSVILLE",
"state": "WI",
"postal_code": "531269704",
"telephone_number": "262-835-9377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8633 32ND AVE",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531425187",
"telephone_number": "262-694-8800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLMS",
"first_name": "TRACY",
"name_prefix": "Mrs.",
"credential": "COTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "WI",
"license": "1233-027",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40825900",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kenosha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.