Active NPI
Lori J Miyazato, OTR
- Occupational Therapist
- Waupun, WI
National Provider Identifier
1659328854
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 3696-026
- Practice address
- 620 W Brown St
Waupun, WI 53963-1702 - Phone
- (920) 324-6544
- NPI assigned
- May 31, 2006
- 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 | 3696-026 | WI | Primary |
Addresses
Primary practice location
620 W Brown St
Waupun, WI 53963-1702
Mailing address
620 W Brown St
Waupun, WI 53963-1702
Phone (920) 324-6544
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40861500 | 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 |
|---|---|---|---|
| 3696-026 | WI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187222400000",
"number": "1659328854",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "620 W BROWN ST",
"city": "WAUPUN",
"state": "WI",
"postal_code": "539631702",
"telephone_number": "920-324-6544"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "620 W BROWN ST",
"city": "WAUPUN",
"state": "WI",
"postal_code": "539631702",
"telephone_number": "920-324-6544"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIYAZATO",
"first_name": "LORI",
"middle_name": "J",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-31",
"last_updated": "2007-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WI",
"license": "3696-026",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40861500",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waupun, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 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.