Active NPI
Dianna Witt, COTA
- Occupational Therapy Assistant
- Port Edwards, WI
National Provider Identifier
1548440142
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 794-027
- Practice address
- 1351 Wisconsin River Dr
Port Edwards, WI 54469-1041 - Phone
- (715) 885-8300
- NPI assigned
- Nov 12, 2007
- Last updated
- Nov 12, 2007
- 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 Therapy Assistant | 224Z00000X | 794-027 | WI | Primary |
Addresses
Primary practice location
1351 Wisconsin River Dr
Port Edwards, WI 54469-1041
Mailing address
1241 3Rd St
Port Edwards, WI 54469-1008
Phone (715) 887-2655
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40719800 | Medicaid | WI |
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 |
|---|---|---|---|
| 794-027 | WI | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194825600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1194825600000",
"number": "1548440142",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1241 3RD ST",
"city": "PORT EDWARDS",
"state": "WI",
"postal_code": "544691008",
"telephone_number": "715-887-2655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1351 WISCONSIN RIVER DR",
"city": "PORT EDWARDS",
"state": "WI",
"postal_code": "544691041",
"telephone_number": "715-885-8300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WITT",
"first_name": "DIANNA",
"name_prefix": "Mrs.",
"credential": "COTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-11-12",
"last_updated": "2007-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "WI",
"license": "794-027",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40719800",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port Edwards, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.