Kaitlyn Cornella-Carlson, OTR

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

7202-26 Issued in WI

Practice address

17280 W North Ave
Brookfield, WI 53045-4366

Phone

(262) 928-8830

NPI assigned

Jun 28, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Prohealth Medical Group Inc.

  • Pediatrics Physician
  • Waukesha, WI
  • NPI 1356322440
  Medicare reassignment NPD
• Prohealth Medical Group Inc

  • Family Medicine Physician
  • Hartland, WI
  • NPI 1386785178
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1656374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656374400000",
    "number": "1831821891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1012 N BLUESPRUCE CIR",
            "city": "HARTLAND",
            "state": "WI",
            "postal_code": "530298681",
            "telephone_number": "262-347-8002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17280 W NORTH AVE",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530454366",
            "telephone_number": "262-928-8830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORNELLA-CARLSON",
        "first_name": "KAITLYN",
        "credential": "OTR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-28",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "WI",
            "license": "7202-26",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maegan Michelle Cook, D.D.S.
• Timothy Chung Cooper, M.D.
• Cheryl Coopman, OTR
• Ashley Corbisier, PTA
• Wesley Cornejo
• Cornerstone Counseling Services, Inc
• Hannah Cory
• Jennifer Marie Costigan, OTR
• Avery Cottrill
• Maria Courchane, DPT

• Pediatric Occupational Therapist in Brookfield, WI
• Providers in Brookfield, WI by specialty
• Pediatric Occupational Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.