Active NPI
Kim R. Ruffalo, OTR, CLT-LANA
- Occupational Therapist
- Oconomowoc, WI
National Provider Identifier
1720008915
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 826-026
- Practice address
- 541 S. Sawyer Rd.
Oconomowoc, WI 53066 - Phone
- (262) 244-7693
- NPI assigned
- Jul 20, 2006
- 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 | 826-026 | WI | Primary |
Addresses
Primary practice location
541 S. Sawyer Rd.
Oconomowoc, WI 53066
Mailing address
541 S. Sawyer Rd.
Oconomowoc, WI 53066
Phone (262) 244-7693
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 826-026 | WI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720008915",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "541 S. SAWYER RD.",
"city": "OCONOMOWOC",
"state": "WI",
"postal_code": "53066",
"telephone_number": "262-244-7693"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "541 S. SAWYER RD.",
"city": "OCONOMOWOC",
"state": "WI",
"postal_code": "53066",
"telephone_number": "262-244-7693"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUFFALO",
"first_name": "KIM",
"middle_name": "R.",
"credential": "OTR, CLT-LANA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WI",
"license": "826-026",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oconomowoc, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.