Active NPI
Sara Simon, OTR
- Occupational Therapist
- Peshtigo, WI
National Provider Identifier
1508173642
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 4873-26
- Practice address
- 701 N. Lake Street
Peshtigo, WI 54157 - Phone
- (715) 582-3962
- NPI assigned
- Sep 10, 2010
- 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 | 4873-26 | WI | Primary |
Addresses
Primary practice location
701 N. Lake Street
Peshtigo, WI 54157
Mailing address
3089 Nuthatch Lane
Oconto, WI 54153
Phone (920) 680-7014
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 |
|---|---|---|---|
| 4873-26 | WI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1284076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1415836800000",
"number": "1508173642",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3089 NUTHATCH LANE",
"city": "OCONTO",
"state": "WI",
"postal_code": "54153",
"telephone_number": "920-680-7014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 N. LAKE STREET",
"city": "PESHTIGO",
"state": "WI",
"postal_code": "54157",
"telephone_number": "715-582-3962"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMON",
"first_name": "SARA",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-09-10",
"last_updated": "2014-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WI",
"license": "4873-26",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peshtigo, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 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.