Active NPI
Lisa Wixon, MS OTR/L
- Occupational Therapist
- Viborg, SD
National Provider Identifier
1831292739
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 0374
- Practice address
- 315 N Washington Street
Viborg, SD 57070-0368 - Phone
- (605) 326-5161
- Fax
- (605) 326-5734
- NPI assigned
- Sep 6, 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 0374 | SD | Primary |
Addresses
Primary practice location
315 N Washington Street
Viborg, SD 57070-0368
Mailing address
131 Broadway St
Centerville, SD 57014-2202
Phone (605) 552-2020
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5833630 | Medicaid | SD |
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0374 | SD | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1831292739",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "131 BROADWAY ST",
"city": "CENTERVILLE",
"state": "SD",
"postal_code": "570142202",
"telephone_number": "605-552-2020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "315 N WASHINGTON STREET",
"city": "VIBORG",
"state": "SD",
"postal_code": "570700368",
"telephone_number": "605-326-5161",
"fax_number": "605-326-5734"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIXON",
"first_name": "LISA",
"credential": "MS OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "SD",
"license": "0374",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5833630",
"state": "SD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Viborg, SD
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.