Sara Dakota Fulghum

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

8155-26 Issued in WI

Practice address

13203 Globe Dr Ste 111
Mount Pleasant, WI 53177-1616

Phone

(262) 287-0090

NPI assigned

Jan 30, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Medical Support Services Inc

  • Rehabilitation Clinic/Center
  • Mount Pleasant, WI
  • NPI 1114143781
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1675036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675036800000",
    "number": "1558077974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6058 109TH AVE",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531427598",
            "telephone_number": "847-702-7363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13203 GLOBE DR STE 111",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "531771616",
            "telephone_number": "262-287-0090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULGHUM",
        "first_name": "SARA",
        "middle_name": "DAKOTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-30",
        "last_updated": "2023-01-30",
        "certification_date": "2023-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WI",
            "license": "8155-26",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Frederickson
• Fresenius Medical Care Midwest Dialysis, LLC
• Ashley C Frey, PT, DPT
• Jason R Friedlander, M.D.
• Katrina Fronberry
• Fusion Counseling and Wellness LLC
• G.S. Miceli, DPM, S.C.
• Daniel James Gage, PHYSICAL THERAPIST
• Rachel R Gage, APN
• Carlos R Galvao-Sobrinho, MD, PHD

• Occupational Therapist in Mount Pleasant, WI
• Providers in Mount Pleasant, WI by specialty
• Occupational Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.