Individual provider Active NPI

Sharon Ann Vanstiphout, COTA

  • Occupational Therapy Assistant
  • Appleton, WI
National Provider Identifier
1740461540
Registry record updated Nov 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
591-027 Issued in WI
Practice address
3375 W Brewster St
Appleton, WI 54914-1602
Phone
(920) 749-5870
NPI assigned
Nov 20, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 591-027 WI Primary

Addresses

Primary practice location

3375 W Brewster St
Appleton, WI 54914-1602

Mailing address

3375 W Brewster St
Appleton, WI 54914-1602
Phone (920) 749-5870

Other identifiers 1

IdentifierTypeStateIssuer
40800000MedicaidWI

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

LicenseStateTypeSpecialty
591-027WIMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Packaging Industries, Inc. Past Accepting new patients

Organizations & group practices 1

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": "1195516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195516800000",
    "number": "1740461540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3375 W BREWSTER ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549141602",
            "telephone_number": "920-749-5870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3375 W BREWSTER ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549141602",
            "telephone_number": "920-749-5870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANSTIPHOUT",
        "first_name": "SHARON",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "COTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-20",
        "last_updated": "2007-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "WI",
            "license": "591-027",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40800000",
            "state": "WI"
        }
    ],
    "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 Nov 20, 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.

Verify at the official NPI Registry.