Individual provider Active NPI

Taryn Mikkelson, OTD, OTR/L

  • Occupational Therapist
  • Brookfield, WI
National Provider Identifier
1689418642
Registry record updated Apr 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
8636 Issued in WI
Practice address
3360 Gateway Rd
Brookfield, WI 53045-5115
Phone
(262) 923-7101
NPI assigned
Jun 24, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 8636 WI Primary

Addresses

Primary practice location

3360 Gateway Rd
Brookfield, WI 53045-5115

Mailing address

3360 Gateway Rd
Brookfield, WI 53045-5115
Phone (262) 923-7101

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

LicenseStateTypeSpecialty
8636WIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Greenfield Rehab Agency Unc. PastSince Jun 30, 2024 Accepting new patients
Greenfield Rehabilitation Agency, Inc. Occupational Therapist PastSince Jun 30, 2024 Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1719187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777507200000",
    "number": "1689418642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3360 GATEWAY RD",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530455115",
            "telephone_number": "262-923-7101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3360 GATEWAY RD",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530455115",
            "telephone_number": "262-923-7101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIKKELSON",
        "first_name": "TARYN",
        "credential": "OTD, OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-24",
        "last_updated": "2026-04-30",
        "certification_date": "2026-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WI",
            "license": "8636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookfield, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2026; 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.