NPIMap

Individual provider Active NPI

Amanda Wandall

  • Occupational Therapist
  • Oak Creek, WI
National Provider Identifier
1386129096
Registry record updated Dec 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
6723-26 Issued in WI
Practice address
140 E Rawson Ave Ste 317
Oak Creek, WI 53154-1525
Phone
(262) 287-0090
NPI assigned
Sep 27, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 056.011910 IL
Occupational Therapist 225X00000X 6723-26 WI Primary

Addresses

Primary practice location

140 E Rawson Ave Ste 317
Oak Creek, WI 53154-1525

Mailing address

140 E Rawson Ave Ste 317
Oak Creek, WI 53154-1525

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

LicenseStateTypeSpecialty
056.011910ILMDOccupational Therapist
6723-26WIMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Bys Speech and Occupational Therapy Services, LLC Occupational Therapist Past Accepting new patients
Medical Support Services Inc PastSince Jan 1, 2023 Accepting new patients

Organizations & group practices 2

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": "1538006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672272000000",
    "number": "1386129096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 E RAWSON AVE STE 317",
            "city": "OAK CREEK",
            "state": "WI",
            "postal_code": "531541525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 E RAWSON AVE STE 317",
            "city": "OAK CREEK",
            "state": "WI",
            "postal_code": "531541525",
            "telephone_number": "262-287-0090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANDALL",
        "first_name": "AMANDA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-27",
        "last_updated": "2022-12-29",
        "certification_date": "2022-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056.011910",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WI",
            "license": "6723-26",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Creek, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.