Active NPI
Patricia Waters, OT
- Occupational Therapist
- West Bend, WI
National Provider Identifier
1457433286
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 836
- Practice address
- 1700 W Paradise Dr
West Bend, WI 53095-9795 - Phone
- (262) 334-3451
- NPI assigned
- Oct 20, 2006
- 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 | 836 | WI | Primary |
Addresses
Primary practice location
1700 W Paradise Dr
West Bend, WI 53095-9795
Mailing address
1190 E Paradise Dr
West Bend, WI 53095-5444
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 23533 | Other | INTERNAL ID-MOTOR VEHICLE ID |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 836 | WI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161302400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1198627200000",
"number": "1457433286",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1190 E PARADISE DR",
"city": "WEST BEND",
"state": "WI",
"postal_code": "530955444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1700 W PARADISE DR",
"city": "WEST BEND",
"state": "WI",
"postal_code": "530959795",
"telephone_number": "262-334-3451"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATERS",
"first_name": "PATRICIA",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-20",
"last_updated": "2007-12-26",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WI",
"license": "836",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INTERNAL ID-MOTOR VEHICLE ID",
"identifier": "23533",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in West Bend, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 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.