Kelly Michelle Norman, P.T.A.

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

528-019 Issued in WI

Practice address

1375 S Carrington LN
De Pere, WI 54115-4227

Phone

(920) 227-7210

NPI assigned

May 22, 2007

Last updated

Jun 17, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Miss Kelly Michelle Kienitz Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• RG-Rhinelander, Inc.

  dba Rennes Health & Rehab Center - Rhinelander

  • Skilled Nursing Facility
  • Rhinelander, WI
  • NPI 1407164312
  NPD (past)

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560729600000",
    "number": "1851500227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1357 PONDEROSA AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543135944",
            "telephone_number": "920-569-6349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1375 S CARRINGTON LN",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541154227",
            "telephone_number": "920-227-7210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NORMAN",
        "first_name": "KELLY",
        "middle_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "credential": "P.T.A.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-22",
        "last_updated": "2019-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WI",
            "license": "528-019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40478800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "KIENITZ",
            "middle_name": "MICHELLE",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sarah Nino
• Jason M Nitke, D.O.
• Nicole Lindsey Nolte Rierdon, SLP
• Nicole Dasya Norcross, MSW CAPSW
• Ashley Nordlund
• Steven John Novotny, MD
• Erin C Nuthals, RN, BSN
• Stephanie O'Connor, LCSW
• Odyssey Healthcare Holding Company (Heartland Hospice (Green Bay))
• Maureen Oldenburg

• Physical Therapy Assistant in De Pere, WI
• Providers in De Pere, WI by specialty
• Physical Therapy Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2019; 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.