Bobay Vangroll, OT – Occupational Therapist

Key facts

NPI: 1679921647
Entity type: Individual (NPI type 1)
Primary specialty: Occupational Therapist 225X00000X
License: 4838-26 (WI)
Practice address: 1650 Tri Park Way
Appleton, WI 54914-1652
Phone: (920) 830-6697
Fax: (920) 830-6707
NPI assigned: May 31, 2016
Sex: Female
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
4838-26	WI	MD	Occupational Therapist

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Occupational Therapist	225X00000X	4838-26	WI	Yes

Addresses

Primary practice location

1650 Tri Park Way
Appleton, WI 54914-1652

Mailing address

1650 Tri Park Way
Appleton, WI 54914-1652
Phone (920) 830-6697

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 31, 2016.

{
    "created_epoch": "1464652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464652800000",
    "number": "1679921647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 TRI PARK WAY",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549141652",
            "telephone_number": "920-830-6697",
            "fax_number": "920-830-6707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 TRI PARK WAY",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549141652",
            "telephone_number": "920-830-6697",
            "fax_number": "920-830-6707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANGROLL",
        "first_name": "BOBAY",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-31",
        "last_updated": "2016-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WI",
            "license": "4838-26",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

All providers in Appleton, WI · Occupational Therapist in Wisconsin

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 31, 2016. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.