Jennifer Sue Kvalheim, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

5262 Issued in WI

Practice address

115 E Arndt St
Fond Du Lac, WI 54935-2461

Phone

(920) 923-7879

NPI assigned

Jan 7, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Ms. Jennifer Sue Frederick Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1609977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609977600000",
    "number": "1841888500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 DONNA ST",
            "city": "CHILTON",
            "state": "WI",
            "postal_code": "530141500",
            "telephone_number": "920-979-1933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 E ARNDT ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549352461",
            "telephone_number": "920-923-7879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KVALHEIM",
        "first_name": "JENNIFER",
        "middle_name": "SUE",
        "name_prefix": "Mrs.",
        "credential": "COTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-07",
        "last_updated": "2021-01-07",
        "certification_date": "2021-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "WI",
            "license": null,
            "primary": false
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "WI",
            "license": "5262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "FREDERICK",
            "middle_name": "SUE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sunil Kumar, M.D.
• Thomas J Kunkel, MD
• Heather Lynn Kuphal, APNP
• Steven R Kuphal
• Lynn Marie Kutz, LMT
• Tai H Kwon, MD
• Carin M Lacount, OD
• Luanne Laib
• Lakeland Care Inc
• Lakeside Neurocare

• Occupational Therapy Assistant in Fond Du Lac, WI
• Providers in Fond Du Lac, WI by specialty
• Occupational Therapy Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.