Active NPI
Naomi Marie Grimm, OTR
- Pediatric Occupational Therapist
- Manitowoc, WI
National Provider Identifier
1770513129
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- 3314-26
- Practice address
- 600 York St
Manitowoc, WI 54220-6845 - Phone
- (920) 320-6750
- Fax
- (920) 682-1981
- NPI assigned
- Jul 3, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 3314-26 | WI | Primary |
Addresses
Primary practice location
600 York St
Manitowoc, WI 54220-6845
Mailing address
2300 Western Ave
PO Box 2170
Manitowoc, WI 54221-2170
Phone (920) 320-8667
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40829000 | Medicaid | WI | |
| 717681 | Other | WI | T19 MANAGED HEALTH SERVIC |
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 |
|---|---|---|---|
| 3314-26 | WI | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1770513129",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2300 WESTERN AVE",
"address_2": "PO BOX 2170",
"city": "MANITOWOC",
"state": "WI",
"postal_code": "542212170",
"telephone_number": "920-320-8667",
"fax_number": "920-320-8616"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 YORK ST",
"city": "MANITOWOC",
"state": "WI",
"postal_code": "542206845",
"telephone_number": "920-320-6750",
"fax_number": "920-682-1981"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRIMM",
"first_name": "NAOMI",
"middle_name": "MARIE",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "WI",
"license": "3314-26",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40829000",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "T19 MANAGED HEALTH SERVIC",
"identifier": "717681",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Manitowoc, WI
Sources for this page
- 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.