William Robert Bahnfleth Jr., M.S. OTR

Key facts

NPI: 1376574756
Entity type: Individual (NPI type 1)
Primary specialty: Pediatric Occupational Therapist 225XP0200X
License: 293026 (WI)
Practice address: 600 York St
Manitowoc, WI 54220-6845
Phone: (920) 320-6750
Fax: (920) 682-1981
NPI assigned: Jul 5, 2006
Sex: Male
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No
Credentials: Master of Science

State licenses

License	State	Type	Specialty
293026	WI	MD	Pediatric Occupational Therapist

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Pediatric Occupational Therapist	225XP0200X	293026	WI	Yes

Addresses

Primary practice location

600 York St
Manitowoc, WI 54220-6845

Mailing address

2300 Western Ave
PO Box 2170
Manitowoc, WI 54221-2170
Phone (920) 320-8667

Other identifiers

Identifier	Type	State	Issuer
40524700	Medicaid	WI
717436	Other	WI	T19 MANAGED HEALTH SERVIC

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1376574756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 WESTERN AVE",
            "address_2": "PO BOX 2170",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542212170",
            "telephone_number": "920-320-8667",
            "fax_number": "920-320-8616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 YORK ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542206845",
            "telephone_number": "920-320-6750",
            "fax_number": "920-682-1981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAHNFLETH",
        "first_name": "WILLIAM",
        "middle_name": "ROBERT",
        "name_suffix": "Jr.",
        "credential": "M.S. OTR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "WI",
            "license": "293026",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40524700",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "T19 MANAGED HEALTH SERVIC",
            "identifier": "717436",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manitowoc, WI

All providers in Manitowoc, WI · Pediatric Occupational Therapist in Wisconsin

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.