Individual provider Active NPI

Colleen Clarice Ruebsamen, OTR, CHT

  • Occupational Therapist
  • Viroqua, WI
National Provider Identifier
1467840694
Registry record updated Dec 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
3932-26 Issued in WI
Practice address
507 S Main St
Viroqua, WI 54665-2059
Phone
(608) 637-2101
NPI assigned
Dec 22, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 3932-26 WI Primary

Addresses

Primary practice location

507 S Main St
Viroqua, WI 54665-2059

Mailing address

S7071 Aikins Rd
Readstown, WI 54652-8046
Phone (608) 637-4385

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210318000991 WI Practitioner - Occupational Therapist in Private Practice 2062829088 Reassigns benefits to 1 organization
I20210903000472 IL Practitioner - Occupational Therapist in Private Practice 2062829088 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
DPT Holdings LLCGroup PAC ID 4688679293, 170 clinicians

Practice addresses (Care Compare)

10320 75TH St
Suite D
Kenosha, WI 53142-7525
Phone (800) 974-4378

417 E Il Route 173
Unit 101
Antioch, IL 60002-9407
Phone (800) 974-4378

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3932-26WIMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
DPT Holdings, LLC CurrentSince May 26, 2021 Accepting new patients

Locations

417 E Il Route 173
Unit 101
Antioch, IL 60002

24014 W Renwick Rd
Ste F
Plainfield, IL 60544
Phone (815) 577-2488

1054 Milwaukee Ave
Ste 100
Burlington, WI 53105

1054 Milwaukee Ave
Ste 200
Burlington, WI 53105
Phone 8009744378 ext. 1829

10320 75th St
Ste D
Kenosha, WI 53142
Phone (262) 909-2820

3825 39th Ave
Ste 110
Kenosha, WI 53144
Phone (262) 605-6810

Organizations & group practices 1

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": "1419206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1419206400000",
    "number": "1467840694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "S7071 AIKINS RD",
            "city": "READSTOWN",
            "state": "WI",
            "postal_code": "546528046",
            "telephone_number": "608-637-4385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 S MAIN ST",
            "city": "VIROQUA",
            "state": "WI",
            "postal_code": "546652059",
            "telephone_number": "608-637-2101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUEBSAMEN",
        "first_name": "COLLEEN",
        "middle_name": "CLARICE",
        "name_prefix": "Ms.",
        "credential": "OTR, CHT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-22",
        "last_updated": "2014-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WI",
            "license": "3932-26",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Viroqua, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.