NPIMap

Individual provider Active NPI

Andrea Labelle Reynolds

  • Neurorehabilitation Occupational Therapist
  • Summit, WI
National Provider Identifier
1629744834
Registry record updated Aug 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurorehabilitation Occupational TherapistTaxonomy code 225XN1300X
License
3094-026 Issued in WI
Practice address
36500 Aurora Dr
Summit, WI 53066-4899
Phone
(262) 434-2600
NPI assigned
Aug 18, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2021

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Occupational Therapist 225XG0600X 3094-026 WI
Occupational Therapist 225X00000X 3094-026 WI
Low Vision Occupational Therapist 225XL0004X 3094-026 WI
Physical Rehabilitation Occupational Therapist 225XP0019X 3094-026 WI
Driving and Community Mobility Occupational Therapist 225XR0403X 3094-026 WI
Neurorehabilitation Occupational Therapist 225XN1300X 3094-026 WI Primary

Addresses

Primary practice location

36500 Aurora Dr
Summit, WI 53066-4899

Mailing address

2457 N 81St St
Wauwatosa, WI 53213-1012
Phone (414) 443-0944

Other names 1

  • Andrea Ryan Labelle Former name

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

LicenseStateTypeSpecialty
3094-026WIMDNeurorehabilitation Occupational Therapist

NPI Registry JSON

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

{
    "created_epoch": "1629244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629244800000",
    "number": "1629744834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2457 N 81ST ST",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532131012",
            "telephone_number": "414-443-0944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36500 AURORA DR",
            "city": "SUMMIT",
            "state": "WI",
            "postal_code": "530664899",
            "telephone_number": "262-434-2600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "ANDREA",
        "middle_name": "LABELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-18",
        "last_updated": "2021-08-18",
        "certification_date": "2021-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XG0600X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Gerontology",
            "state": "WI",
            "license": "3094-026",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WI",
            "license": "3094-026",
            "primary": false
        },
        {
            "code": "225XL0004X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Low Vision",
            "state": "WI",
            "license": "3094-026",
            "primary": false
        },
        {
            "code": "225XP0019X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Physical Rehabilitation",
            "state": "WI",
            "license": "3094-026",
            "primary": false
        },
        {
            "code": "225XR0403X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Driving and Community Mobility",
            "state": "WI",
            "license": "3094-026",
            "primary": false
        },
        {
            "code": "225XN1300X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Neurorehabilitation",
            "state": "WI",
            "license": "3094-026",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANDREA",
            "last_name": "LABELLE",
            "middle_name": "RYAN",
            "credential": "OT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Summit, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2021; 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.