Elizabeth Ann McClelland

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

438074 Issued in WI

Practice address

614 S Rock Ave
Viroqua, WI 54665-1936

Phone

(608) 637-6337

NPI assigned

Jun 19, 2012

Sex

Female

Sole proprietor

Yes

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.

• County of Vernon

  • Skilled Nursing Facility
  • Viroqua, WI
  • NPI 1750324687
  NPD
• County of Vernon

  • Public Health or Welfare Agency
  • Viroqua, WI
  • NPI 1770749764
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

• Elizabeth Ann Fanta Former name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 25, 2023.

{
    "created_epoch": "1340064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692921600000",
    "number": "1649533217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 FAIRLANE DR",
            "city": "VIROQUA",
            "state": "WI",
            "postal_code": "54665",
            "telephone_number": "608-637-5422",
            "fax_number": "608-637-5441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "614 S ROCK AVE",
            "city": "VIROQUA",
            "state": "WI",
            "postal_code": "546651936",
            "telephone_number": "608-637-6337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCLELLAND",
        "first_name": "ELIZABETH",
        "middle_name": "ANN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-19",
        "last_updated": "2023-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "WI",
            "license": "438074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "FANTA",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Melanie Martinez, CPM, LM
• Sara Elizabeth Martinez, RN
• Barbara L Mattice
• Ryan C Maurer
• Olivia Katherine Maxinoski, COTA
• Troy D McKay, OD
• Heidi Kathleen McKinley, LPC
• Jessica Merzenich
• Randy J Mickelson, PA
• Brian L Miller, CRNA

• All providers in Viroqua, WI
• Occupational Therapy Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 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.