Individual provider Active NPI

Leslie M Koenig, OT

  • Occupational Therapist
  • Appleton, WI
National Provider Identifier
1730693888
Registry record updated Jun 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
6182-26 Issued in WI
Practice address
2323 N Casaloma Dr
Appleton, WI 54913-8284
Phone
(920) 730-8833
NPI assigned
Nov 28, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2021

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 6182-26 WI Primary

Addresses

Primary practice location

2323 N Casaloma Dr
Appleton, WI 54913-8284

Mailing address

2323 N Casaloma Dr
Appleton, WI 54913-8284
Phone (920) 730-8833

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171208000658 WI Practitioner - Occupational Therapist in Private Practice 6608133152 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hand to Shoulder Center of Wisconsin, LTD.Group PAC ID 6901884337, 34 clinicians

Practice addresses (Care Compare)

2323 N Casaloma Dr
Appleton, WI 54913-8284
Phone (920) 730-8833

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6182-26WIMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Hand to Shoulder Center of Wisconsin, LTD. CurrentSince Jun 1, 2021 Accepting new patients
Hand to Shoulder Center of Wisconsin, LTD. CurrentSince Jun 1, 2021 Accepting new patients

Locations

2323 N Casaloma Dr
Appleton, WI 54913

1551 Park Pl
Green Bay, WI 54304
Phone (773) 551-9490

1551 Park Pl
Ste 100
Green Bay, WI 54304

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": "1511827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625011200000",
    "number": "1730693888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2323 N CASALOMA DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549138284",
            "telephone_number": "920-730-8833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2323 N CASALOMA DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549138284",
            "telephone_number": "920-730-8833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOENIG",
        "first_name": "LESLIE",
        "middle_name": "M",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-28",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WI",
            "license": "6182-26",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.