Active NPI
Gayle Renz
- Occupational Therapy Assistant
- Jefferson, WI
National Provider Identifier
1346485646
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 905-027
- Practice address
- 1130 Collins Rd
Jefferson, WI 53549-2939 - Phone
- (920) 674-3170
- NPI assigned
- Dec 16, 2008
- 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 | 905-027 | WI | Primary |
Addresses
Primary practice location
1130 Collins Rd
Jefferson, WI 53549-2939
Mailing address
N6781 Sunset Rd
Lake Mills, WI 53551-9767
Phone (920) 723-0253
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 |
|---|---|---|---|
| 905-027 | WI | MD | Occupational Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| NSH Summit 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 and National Provider Directory roles.
-
- Skilled Nursing Facility
- Oconomowoc, WI
- NPI 1033637889
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1229385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1229385600000",
"number": "1346485646",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "N6781 SUNSET RD",
"city": "LAKE MILLS",
"state": "WI",
"postal_code": "535519767",
"telephone_number": "920-723-0253"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1130 COLLINS RD",
"city": "JEFFERSON",
"state": "WI",
"postal_code": "535492939",
"telephone_number": "920-674-3170"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RENZ",
"first_name": "GAYLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-12-16",
"last_updated": "2008-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "WI",
"license": "905-027",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jefferson, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.