Individual provider Active NPI

Traci Pavletich, OT

  • Occupational Therapist
  • Brookfield, WI
National Provider Identifier
1336527357
Registry record updated May 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
1207 Issued in WI
Practice address
1350 S Sunny Slope Rd
Brookfield, WI 53005-7060
Phone
(414) 805-9600
Fax
(414) 805-9645
NPI assigned
May 11, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 1207 WI Primary

Addresses

Primary practice location

1350 S Sunny Slope Rd
Brookfield, WI 53005-7060

Mailing address

1350 S Sunny Slope Rd
Brookfield, WI 53005-7060
Phone (414) 805-9600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151109000764 WI Practitioner - Occupational Therapist in Private Practice 4688984339 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1350 S Sunny Slope Rd
Brookfield, WI 53005-7060
Phone (414) 805-9600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1207WIMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Sep 9, 2015 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Sep 9, 2015 Accepting new patients
The Medical College of Wisconsin, Inc. Current Accepting new patients
Ascension Medical Group-Southeast Wisconsin Inc CurrentSince Jan 20, 2017 Accepting new patients

Locations

13950 W Capitol Dr
Brookfield, WI 53005
Phone (414) 302-5400

1350 S Sunny Slope Rd
Brookfield, WI 53005
Phone (262) 798-8750

W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060

110 Lone Oak Ln
Hartford, WI 53027
Phone (262) 670-1800

4805 S Moorland Rd
New Berlin, WI 53151
Phone (262) 798-7200

201 N Mayfair Rd
Fl 2
Wauwatosa, WI 53226
Phone (414) 771-8228

1155 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 955-5990

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1431302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431302400000",
    "number": "1336527357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 S SUNNY SLOPE RD",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530057060",
            "telephone_number": "414-805-9600",
            "fax_number": "414-805-9645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 S SUNNY SLOPE RD",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530057060",
            "telephone_number": "414-805-9600",
            "fax_number": "414-805-9645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAVLETICH",
        "first_name": "TRACI",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-11",
        "last_updated": "2015-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WI",
            "license": "1207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookfield, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.