Active NPI
Jamie L. Carter, OTR
- Occupational Therapist
- Random Lake, WI
National Provider Identifier
1679701742
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 1136026
- Practice address
- 402 First Street
Random Lake, WI 53075 - Phone
- (920) 994-9700
- NPI assigned
- Jun 29, 2009
- 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 | 1136026 | WI | Primary |
Addresses
Primary practice location
402 First Street
Random Lake, WI 53075
Mailing address
4872 Woodhaven Dr
West Bend, WI 53095-9155
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1136026 | WI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1246233600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1246233600000",
"number": "1679701742",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4872 WOODHAVEN DR",
"city": "WEST BEND",
"state": "WI",
"postal_code": "530959155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "402 FIRST STREET",
"city": "RANDOM LAKE",
"state": "WI",
"postal_code": "53075",
"telephone_number": "920-994-9700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARTER",
"first_name": "JAMIE",
"middle_name": "L.",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-06-29",
"last_updated": "2009-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WI",
"license": "1136026",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Random Lake, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.