Body & Soul MFR Therapy LLC

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

Legal business name

BODY & SOUL MFR THERAPY LLC

Practice address

110 Packerland Dr Ste C2
Green Bay, WI 54303-4861

Phone

(920) 209-0012

Fax

(920) 888-2409

NPI assigned

Apr 21, 2022

Organization subpart

Yes

Parent organization

BODY & SOUL MFR THERAPY LLCAs reported in NPPES

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

Authorized official

Name

Yvonne Vander Heiden, COTANPI 1316316730

Title

Owner

Phone

(920) 209-0012

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Part of

Body Soul MFR Therapy LLC

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kimberly Ann Fitzgerald, OTR

  • Occupational Therapist
  • Fond Du Lac, WI
  • NPI 1972717460
  Medicare reassignment NPD
• Yvonne Vander Heiden, COTA

  • Occupational Therapy Assistant
  • Green Bay, WI
  • NPI 1316316730
  NPD Authorized official

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

{
    "created_epoch": "1650499200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704153600000",
    "number": "1376287896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 W TOWN RD",
            "city": "PULASKI",
            "state": "WI",
            "postal_code": "541629278",
            "telephone_number": "920-209-0012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 PACKERLAND DR STE C2",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543034861",
            "telephone_number": "920-209-0012",
            "fax_number": "920-888-2409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BODY & SOUL MFR THERAPY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BODY & SOUL MFR THERAPY LLC",
        "enumeration_date": "2022-04-21",
        "last_updated": "2024-01-02",
        "certification_date": "2024-01-02",
        "status": "A",
        "authorized_official_last_name": "VANDER HEIDEN",
        "authorized_official_first_name": "YVONNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-209-0012",
        "authorized_official_credential": "COTA"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Martin Bochenek, MD
• Mark W Bocik, CRNA
• Michael Bodart, PT
• James Boddy
• Sara Lea Bodem, PHYSICAL THERAPIST
• Amanda Lee Boeckman
• Nicholas Michael Boege, PHARMD
• Brandon E Boehm, MD
• Katie L Boehm, D-PT
• Marcus A Boehm, DPT

• Occupational Therapist in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Occupational Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.