Active NPI
Katelyn Long
- Occupational Therapy Assistant
- Hazel Green, WI
National Provider Identifier
1851157093
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 5503-27
- Practice address
- 2375 Sinsinawa Rd
Hazel Green, WI 53811-9707 - Phone
- (920) 988-2180
- NPI assigned
- Feb 26, 2024
- 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 Therapy Assistant | 224Z00000X | 5503-27 | WI | Primary |
Addresses
Primary practice location
2375 Sinsinawa Rd
Hazel Green, WI 53811-9707
Mailing address
147 W Estey St
Shullsburg, WI 53586-9524
Phone (815) 275-4900
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 |
|---|---|---|---|
| 5503-27 | WI | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1708905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709078400000",
"number": "1851157093",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "147 W ESTEY ST",
"city": "SHULLSBURG",
"state": "WI",
"postal_code": "535869524",
"telephone_number": "815-275-4900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2375 SINSINAWA RD",
"city": "HAZEL GREEN",
"state": "WI",
"postal_code": "538119707",
"telephone_number": "920-988-2180"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONG",
"first_name": "KATELYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-02-26",
"last_updated": "2024-02-28",
"certification_date": "2024-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "WI",
"license": "5503-27",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hazel Green, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.