Active NPI
Lisa Stark-Jones, OTR
- Occupational Therapist
- De Pere, WI
National Provider Identifier
1376669655
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 286-026
- Practice address
- 1142 Orlando Dr
De Pere, WI 54115-9484 - Phone
- (920) 339-0700
- Fax
- (920) 330-0278
- NPI assigned
- Mar 21, 2007
- 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 | 286-026 | WI | Primary |
Addresses
Primary practice location
1142 Orlando Dr
De Pere, WI 54115-9484
Mailing address
2680 Foxfire Dr
Green Bay, WI 54311-6790
Phone (920) 469-3546
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40739300 | Medicaid | WI |
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 |
|---|---|---|---|
| 286-026 | WI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376669655",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2680 FOXFIRE DR",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543116790",
"telephone_number": "920-469-3546"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1142 ORLANDO DR",
"city": "DE PERE",
"state": "WI",
"postal_code": "541159484",
"telephone_number": "920-339-0700",
"fax_number": "920-330-0278"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STARK-JONES",
"first_name": "LISA",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WI",
"license": "286-026",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40739300",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in De Pere, WI
- St Vincent Hospital-Hospital Sisters-Third Order of St Francis
- St Vincent Hospital-Hospital Sisters-Third Order of St Francis
- St. Vincent Hospital-Hospital Sisters-Third Order of St. Francis
- Carole M St.Laurent-Groves, LPC
- John R Stamm, MD
- Rhonda Steffel-Heling, MD
- Scott M Stillwell, M.D.
- Amy Stirk
- Cole Joseph Stockheimer, DDS
- Kaitlyn Rikke Stollberg
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.