Active NPI
Carrie Ann Jennerjohn, OTR
- Occupational Therapist
- Milwaukee, WI
National Provider Identifier
1417214628
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 5174-26
- Practice address
- 120 E National Ave
Apt 105
Milwaukee, WI 53204-1879 - Phone
- (414) 416-0148
- NPI assigned
- Apr 12, 2012
- 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 | 5174-26 | WI | Primary |
Addresses
Primary practice location
120 E National Ave
Apt 105
Milwaukee, WI 53204-1879
Mailing address
120 E National Ave
Apt 105
Milwaukee, WI 53204-1879
Phone (414) 416-0148
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 |
|---|---|---|---|
| 5174-26 | WI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1334188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1334188800000",
"number": "1417214628",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 E NATIONAL AVE",
"address_2": "APT 105",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532041879",
"telephone_number": "414-416-0148"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 E NATIONAL AVE",
"address_2": "APT 105",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532041879",
"telephone_number": "414-416-0148"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENNERJOHN",
"first_name": "CARRIE",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-04-12",
"last_updated": "2012-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WI",
"license": "5174-26",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 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.