Active NPI
Jennifer L. Mennicke Anderson
- Neurorehabilitation Occupational Therapist
- Madison, WI
National Provider Identifier
1831297613
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurorehabilitation Occupational Therapist
- License
- 3258-026
- Practice address
- 317 Knutson Dr
Madison, WI 53704-1133 - Phone
- (608) 301-9378
- NPI assigned
- Sep 20, 2006
- 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 |
|---|---|---|---|---|
| Neurorehabilitation Occupational Therapist | 225XN1300X | 3258-026 | WI | Primary |
Addresses
Primary practice location
317 Knutson Dr
Madison, WI 53704-1133
Mailing address
317 Knutson Dr
Madison, WI 53704-1133
Phone (608) 228-9341
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 |
|---|---|---|---|
| 3258-026 | WI | MD | Neurorehabilitation Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641859200000",
"number": "1831297613",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "317 KNUTSON DR",
"city": "MADISON",
"state": "WI",
"postal_code": "537041133",
"telephone_number": "608-228-9341"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "317 KNUTSON DR",
"city": "MADISON",
"state": "WI",
"postal_code": "537041133",
"telephone_number": "608-301-9378"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENNICKE ANDERSON",
"first_name": "JENNIFER",
"middle_name": "L.",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-20",
"last_updated": "2022-01-11",
"certification_date": "2022-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "225XN1300X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Neurorehabilitation",
"state": "WI",
"license": "3258-026",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.