Active NPI
Marissa Purdoff, MS, LAT
- Athletic Trainer
- Sheboygan, WI
National Provider Identifier
1477979599
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 1375-39
- Practice address
- 2629 N 7TH St
Sheboygan, WI 53083-4932 - Phone
- (920) 451-5559
- NPI assigned
- Mar 13, 2014
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 1375-39 | WI | Primary |
Addresses
Primary practice location
2629 N 7TH St
Sheboygan, WI 53083-4932
Mailing address
8800 W Marshfield CT
Franklin, WI 53132-8595
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1375-39 | WI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1394668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1394668800000",
"number": "1477979599",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8800 W MARSHFIELD CT",
"city": "FRANKLIN",
"state": "WI",
"postal_code": "531328595"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2629 N 7TH ST",
"city": "SHEBOYGAN",
"state": "WI",
"postal_code": "530834932",
"telephone_number": "920-451-5559"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PURDOFF",
"first_name": "MARISSA",
"credential": "MS, LAT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-03-13",
"last_updated": "2014-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WI",
"license": "1375-39",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sheboygan, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.