Steve Kegel, COTA
Individual provider Active NPI Occupational Therapy Assistant · Shawno, WI
NPI 1780102384 · NPPES record last updated Mar 17, 2018
Key facts
- NPI
- 1780102384
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- 5386-27 (WI)
- Practice address
- 1436 S Lincoln St
Shawno, WI 54166 - Phone
- (715) 526-6111
- Fax
- (715) 524-5708
- NPI assigned
- Sep 3, 2017
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5386-27 | WI | MD | Occupational Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 5386-27 | WI | Yes |
Addresses
Primary practice location
1436 S Lincoln St
Shawno, WI 54166
Mailing address
1436 S Lincoln St
Shawno, WI 54166
Phone (715) 526-6111
Other practice location 1
107 E Beckert Rd
New London, WI 54961
Phone (920) 982-5354
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.