Tracy Rae Johanneck-Utphall, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

1193-27 Issued in WI

Practice address

3248 Shortridge Dr
Racine, WI 53402-1367

Phone

(414) 550-6670

NPI assigned

Nov 12, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Miss Tracy Rae Johanneck Former name

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": "1257984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257984000000",
    "number": "1730416769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3248 SHORTRIDGE DR",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534021367",
            "telephone_number": "414-550-6670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3248 SHORTRIDGE DR",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534021367",
            "telephone_number": "414-550-6670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHANNECK-UTPHALL",
        "first_name": "TRACY",
        "middle_name": "RAE",
        "name_prefix": "Mrs.",
        "credential": "COTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-12",
        "last_updated": "2009-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "WI",
            "license": "1193-27",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WISCONSIN LICIENSURE",
            "identifier": "1193-27",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACY",
            "last_name": "JOHANNECK",
            "middle_name": "RAE",
            "prefix": "MISS",
            "credential": "COTA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Occupational Therapy Assistant in Racine, WI
• Providers in Racine, WI by specialty
• Occupational Therapy Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 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.

Verify at the official NPI Registry.