Active NPI
Ashley Russell
- Occupational Therapist
- Germantown, WI
National Provider Identifier
1336501915
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 5649
- Practice address
- W175 N11117 Stonewood Drive
Suite 100
Germantown, WI 53022 - Phone
- (262) 780-3813
- NPI assigned
- Mar 23, 2016
- Last updated
- Jun 21, 2017
- 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 | 5649 | WI | Primary |
Addresses
Primary practice location
W175 N11117 Stonewood Drive
Suite 100
Germantown, WI 53022
Mailing address
19525 W North Ave
Brookfield, WI 53045-4107
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 |
|---|---|---|---|
| 5649 | WI | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1458691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1498003200000",
"number": "1336501915",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19525 W NORTH AVE",
"city": "BROOKFIELD",
"state": "WI",
"postal_code": "530454107"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "W175 N11117 STONEWOOD DRIVE",
"address_2": "SUITE 100",
"city": "GERMANTOWN",
"state": "WI",
"postal_code": "53022",
"telephone_number": "262-780-3813"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "ASHLEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-03-23",
"last_updated": "2017-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WI",
"license": "5649",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Germantown, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.