Active NPI
Ryan Patrick Bourdelais
- Occupational Therapist
- De Pere, WI
National Provider Identifier
1467968313
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 6155
- Practice address
- 200 S 9TH St
De Pere, WI 54115-1393 - Phone
- (920) 338-4146
- NPI assigned
- Dec 14, 2017
- Sex
- Male
- 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 | 6155 | WI | Primary |
Addresses
Primary practice location
200 S 9TH St
De Pere, WI 54115-1393
Mailing address
2002 Pink Dogwood Way
Suamico, WI 54313-3241
Phone (715) 923-1080
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 |
|---|---|---|---|
| 6155 | WI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1513209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1513209600000",
"number": "1467968313",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2002 PINK DOGWOOD WAY",
"city": "SUAMICO",
"state": "WI",
"postal_code": "543133241",
"telephone_number": "715-923-1080"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 S 9TH ST",
"city": "DE PERE",
"state": "WI",
"postal_code": "541151393",
"telephone_number": "920-338-4146"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOURDELAIS",
"first_name": "RYAN",
"middle_name": "PATRICK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-12-14",
"last_updated": "2017-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WI",
"license": "6155",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in De Pere, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.