Active NPI
Regina Marie Leary, COTA
- Occupational Therapy Assistant
- Peshtigo, WI
National Provider Identifier
1295967743
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 741-27
- Practice address
- 261 French Street
Peshtigo, WI 54157 - Phone
- (715) 582-2200
- Fax
- (715) 582-2222
- NPI assigned
- Aug 18, 2009
- 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 | 741-27 | WI | Primary |
Addresses
Primary practice location
261 French Street
Peshtigo, WI 54157
Mailing address
4435 Brookside Cemetery Rd
Abrams, WI 54101
Phone (920) 826-2306
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40714600 | 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 |
|---|---|---|---|
| 741-27 | WI | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1250553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348444800000",
"number": "1295967743",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4435 BROOKSIDE CEMETERY RD",
"city": "ABRAMS",
"state": "WI",
"postal_code": "54101",
"telephone_number": "920-826-2306"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "261 FRENCH STREET",
"city": "PESHTIGO",
"state": "WI",
"postal_code": "54157",
"telephone_number": "715-582-2200",
"fax_number": "715-582-2222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEARY",
"first_name": "REGINA",
"middle_name": "MARIE",
"credential": "COTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-08-18",
"last_updated": "2012-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "WI",
"license": "741-27",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40714600",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Peshtigo, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.