Patricia Fuller, OTR

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

2196-026 Issued in WI

Practice address

504 Lakeland Rd
Shawano, WI 54166-3836

Phone

(715) 526-5547

NPI assigned

Apr 18, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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": "1208476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208476800000",
    "number": "1689848764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 S LINCOLN ST",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "541662915",
            "telephone_number": "715-524-5094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 LAKELAND RD",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "541663836",
            "telephone_number": "715-526-5547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "PATRICIA",
        "name_prefix": "Mrs.",
        "credential": "OTR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-18",
        "last_updated": "2008-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "WI",
            "license": "2196-026",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40622700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Marie Franke, MS, LPC
• Susan Franke, PA
• Fresenius Medical Care Shawano, LLC (Fresenius Kidney Care Shawano)
• Mindy Maria Frimodig, DO
• Jennifer Frost
• Meghan L Gallagher, M.S.-CCC.SLP
• Veronica Gehrman, NP
• Ashley R Genke
• Jordan Giessel, RN
• Anna G Gilbertson, MD

• Pediatric Occupational Therapist in Shawano, WI
• Providers in Shawano, WI by specialty
• Pediatric Occupational Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2008; 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.