Active NPI
Amanda Huerta
- Occupational Therapy Assistant
- Delavan, WI
National Provider Identifier
1902686405
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 500605
- Practice address
- 1121 Sequoia St
Delavan, WI 53115-1513 - Phone
- (262) 325-6117
- NPI assigned
- Oct 2, 2023
- Last updated
- Oct 2, 2023
- Sex
- Female
- Sole proprietor
- Yes
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 | 500605 | WI | Primary |
Addresses
Primary practice location
1121 Sequoia St
Delavan, WI 53115-1513
Mailing address
1121 Sequoia St
Delavan, WI 53115-1513
Phone (262) 325-6117
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 |
|---|---|---|---|
| 500605 | WI | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1696204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696204800000",
"number": "1902686405",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1121 SEQUOIA ST",
"city": "DELAVAN",
"state": "WI",
"postal_code": "531151513",
"telephone_number": "262-325-6117"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1121 SEQUOIA ST",
"city": "DELAVAN",
"state": "WI",
"postal_code": "531151513",
"telephone_number": "262-325-6117"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUERTA",
"first_name": "AMANDA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-10-02",
"last_updated": "2023-10-02",
"certification_date": "2023-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "WI",
"license": "500605",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Delavan, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.