William T Whalen IV, C.O.

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

213000315 Issued in IL

Practice address

5027 Green Bay Rd
Suite 124
Kenosha, WI 53144-1771

Phone

(262) 654-4300

Fax

(262) 654-4305

NPI assigned

Mar 19, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1395187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395187200000",
    "number": "1689091316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5027 GREEN BAY RD",
            "address_2": "SUITE 124",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531441771",
            "telephone_number": "262-654-4300",
            "fax_number": "262-654-4305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5027 GREEN BAY RD",
            "address_2": "SUITE 124",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531441771",
            "telephone_number": "262-654-4300",
            "fax_number": "262-654-4305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHALEN",
        "first_name": "WILLIAM",
        "middle_name": "T",
        "name_prefix": "Mr.",
        "name_suffix": "IV",
        "credential": "C.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-03-19",
        "last_updated": "2014-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "IL",
            "license": "213000315",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas S Werbie, M.D.
• Jaclyn K Weston, PT
• Cathy Ann Westover, P.T.
• James M. Westover, MA, LPC
• Kimberly Joann Whalen, DPT
• James J White, CERTIFIED OPTICIAN
• Rayme White, OTR/L
• Therese Marie Whitt, MD
• Maryann Cathrine Widzins, RN
• Melissa Wiedenhoeft, MS, CF-SLP

• Prosthetic/Orthotic Supplier in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Prosthetic/Orthotic Supplier in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2014; 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.