Active NPI
Carly Teeters
- Athletic Trainer
- Cedarburg, WI
National Provider Identifier
1770104804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 1611-39
- Practice address
- W68N611 Evergreen Blvd
Cedarburg, WI 53012-1847 - Phone
- (262) 492-9567
- NPI assigned
- Apr 29, 2020
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 1611-39 | WI | Primary |
Addresses
Primary practice location
W68N611 Evergreen Blvd
Cedarburg, WI 53012-1847
Mailing address
4540 W Country View Dr
Mequon, WI 53092-2130
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
| License | State | Type | Specialty |
|---|---|---|---|
| 1611-39 | WI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1588118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588118400000",
"number": "1770104804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4540 W COUNTRY VIEW DR",
"city": "MEQUON",
"state": "WI",
"postal_code": "530922130"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "W68N611 EVERGREEN BLVD",
"city": "CEDARBURG",
"state": "WI",
"postal_code": "530121847",
"telephone_number": "262-492-9567"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TEETERS",
"first_name": "CARLY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-04-29",
"last_updated": "2020-04-29",
"certification_date": "2020-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WI",
"license": "1611-39",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cedarburg, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.