Active NPI
Kelsey Lynn Pustina, OTR/L
- Occupational Therapist
- Baraboo, WI
National Provider Identifier
1891209839
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- Practice address
- 1414 Jefferson St
Baraboo, WI 53913 - Phone
- (608) 356-1400
- NPI assigned
- Nov 29, 2017
- Last updated
- Jul 23, 2018
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 056012203 | IL | |
| Occupational Therapist | 225X00000X | NU | Primary |
Addresses
Primary practice location
1414 Jefferson St
Baraboo, WI 53913
Mailing address
600 Highland Avenue
Madison, WI 53792
Other practice location 1
600 Highland Avenue
Madison, WI 53792
Phone (608) 263-8060
Other practice location 2
1500 Waukegan Rd Ste 250
Glenview, IL 60025-2165
Phone (847) 657-9445
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922067636 | Medicaid | WI |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 056012203 | IL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1511913600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1532304000000",
"number": "1891209839",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 HIGHLAND AVENUE",
"city": "MADISON",
"state": "WI",
"postal_code": "53792"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1414 JEFFERSON ST",
"city": "BARABOO",
"state": "WI",
"postal_code": "53913",
"telephone_number": "608-356-1400"
}
],
"practiceLocations": [
{
"address_1": "600 Highland Avenue",
"address_purpose": "LOCATION",
"city": "Madison",
"state": "WI",
"postal_code": "53792",
"country_code": "US",
"telephone_number": "608-263-8060",
"fax_number": "608-262-7679",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1500 Waukegan Rd Ste 250",
"address_purpose": "LOCATION",
"city": "Glenview",
"state": "IL",
"postal_code": "600252165",
"country_code": "US",
"telephone_number": "847-657-9445",
"fax_number": "847-657-9450",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PUSTINA",
"first_name": "KELSEY",
"middle_name": "LYNN",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-11-29",
"last_updated": "2018-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IL",
"license": "056012203",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1922067636",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Baraboo, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.