Active NPI
Alisa Tabatha Wagner, OTR
- Occupational Therapist
- MC Farland, WI
National Provider Identifier
1710121793
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 4056-026
- Practice address
- 5910 Red Oak TRL
MC Farland, WI 53558-8828 - Phone
- (608) 217-9924
- NPI assigned
- Apr 22, 2009
- Sex
- Female
- Sole proprietor
- Yes
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 | 4056-026 | WI | Primary |
Addresses
Primary practice location
5910 Red Oak TRL
MC Farland, WI 53558-8828
Mailing address
5910 Red Oak TRL
MC Farland, WI 53558-8828
Phone (608) 217-9924
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 225X00000X | Medicaid | WI |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 4056-026 | WI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1240358400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1240358400000",
"number": "1710121793",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5910 RED OAK TRL",
"city": "MC FARLAND",
"state": "WI",
"postal_code": "535588828",
"telephone_number": "608-217-9924"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5910 RED OAK TRL",
"city": "MC FARLAND",
"state": "WI",
"postal_code": "535588828",
"telephone_number": "608-217-9924"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "ALISA",
"middle_name": "TABATHA",
"credential": "OTR",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-04-22",
"last_updated": "2009-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WI",
"license": "4056-026",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "225X00000X",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in MC Farland, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 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.