Pamela Sue Speckbrock, OTR

Primary specialty

Driving and Community Mobility Occupational TherapistTaxonomy code 225XR0403X

License

3103026 Issued in WI

Practice address

901 Mulberry St
Lake Mills, WI 53551-1335

Phone

(920) 648-8344

NPI assigned

May 2, 2007

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

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": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1750502035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5212 MESA RD",
            "city": "MONONA",
            "state": "WI",
            "postal_code": "537162915",
            "telephone_number": "608-221-8275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 MULBERRY ST",
            "city": "LAKE MILLS",
            "state": "WI",
            "postal_code": "535511335",
            "telephone_number": "920-648-8344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPECKBROCK",
        "first_name": "PAMELA",
        "middle_name": "SUE",
        "name_prefix": "Ms.",
        "credential": "OTR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XR0403X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Driving and Community Mobility",
            "state": "WI",
            "license": "3103026",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40853500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in Lake Mills, WI
• Providers in Lake Mills, WI by specialty
• Occupational Therapist in Wisconsin

• 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.

Verify at the official NPI Registry.