Active NPI
Dianne Marie Goettl, NCR REFLEXOLOGIST
- Reflexologist
- Bloomer, WI
National Provider Identifier
1508013566
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Reflexologist
- License
- B01208
- Practice address
- 1610 Main Street
Bloomer, WI 54724 - Phone
- (715) 568-5173
- Fax
- (715) 568-2673
- NPI assigned
- Aug 21, 2008
- Last updated
- Aug 21, 2008
- 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 |
|---|---|---|---|---|
| Reflexologist | 173C00000X | B01208 | WI | Primary |
Addresses
Primary practice location
1610 Main Street
Bloomer, WI 54724
Mailing address
1610 Main Street
Bloomer, WI 54724
Phone (715) 568-5173
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9455705 | Other | WI | COMMUNITY HEALTH PARTNERSHIP |
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 |
|---|---|---|---|
| B01208 | WI | MD | Reflexologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219276800000",
"number": "1508013566",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1610 MAIN STREET",
"city": "BLOOMER",
"state": "WI",
"postal_code": "54724",
"telephone_number": "715-568-5173",
"fax_number": "715-568-2673"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1610 MAIN STREET",
"city": "BLOOMER",
"state": "WI",
"postal_code": "54724",
"telephone_number": "715-568-5173",
"fax_number": "715-568-2673"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOETTL",
"first_name": "DIANNE",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "NCR REFLEXOLOGIST",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-08-21",
"last_updated": "2008-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "173C00000X",
"taxonomy_group": "",
"desc": "Reflexologist",
"state": "WI",
"license": "B01208",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMMUNITY HEALTH PARTNERSHIP",
"identifier": "9455705",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bloomer, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.