Active NPI
Jane Ann Bruesch, OTR
- Occupational Therapist
- Sturgeon Bay, WI
National Provider Identifier
1952336331
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 358026
- Practice address
- 3987 Bay Shore Drive
Sturgeon Bay, WI 54235-2364 - Phone
- (920) 743-8043
- Fax
- (920) 743-4948
- NPI assigned
- Jul 12, 2006
- 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 Therapist | 225X00000X | 358026 | WI | Primary |
Addresses
Primary practice location
3987 Bay Shore Drive
Sturgeon Bay, WI 54235-2364
Mailing address
3987 Bay Shore Drive
Sturgeon Bay, WI 54235-2364
Phone (920) 743-8043
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40610900 | 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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 358026 | WI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1952336331",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3987 BAY SHORE DRIVE",
"city": "STURGEON BAY",
"state": "WI",
"postal_code": "542352364",
"telephone_number": "920-743-8043",
"fax_number": "920-743-4948"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3987 BAY SHORE DRIVE",
"city": "STURGEON BAY",
"state": "WI",
"postal_code": "542352364",
"telephone_number": "920-743-8043",
"fax_number": "920-743-4948"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUESCH",
"first_name": "JANE",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WI",
"license": "358026",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40610900",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sturgeon Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.