Active NPI
Christine Lee Smith, COTA
- Occupational Therapy Assistant
- Montello, WI
National Provider Identifier
1386769867
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 1415-27
- Practice address
- 251 Forest LN
Montello, WI 53949-9380 - Phone
- (608) 297-2153
- Fax
- (608) 297-9328
- 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 Therapy Assistant | 224Z00000X | 1415-27 | WI | Primary |
Addresses
Primary practice location
251 Forest LN
Montello, WI 53949-9380
Mailing address
N6835 Raymond Rd
Pardeeville, WI 53954-9595
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40815800 | 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 |
|---|---|---|---|
| 1415-27 | WI | MD | Occupational Therapy Assistant |
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": "1347235200000",
"number": "1386769867",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "N6835 RAYMOND RD",
"city": "PARDEEVILLE",
"state": "WI",
"postal_code": "539549595"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "251 FOREST LN",
"city": "MONTELLO",
"state": "WI",
"postal_code": "539499380",
"telephone_number": "608-297-2153",
"fax_number": "608-297-9328"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "CHRISTINE",
"middle_name": "LEE",
"credential": "COTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-21",
"last_updated": "2012-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "WI",
"license": "1415-27",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40815800",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Montello, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.