Sunshine J Broeren, OTRL
Individual provider Active NPI Occupational Therapist · Amery, WI
NPI 1992867659 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1992867659
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 3961026 (WI)
- Practice address
- 505 Keller Ave S
Amery, WI 54001 - Phone
- (715) 268-6900
- Fax
- (715) 268-6895
- NPI assigned
- Dec 15, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Occupational Therapist in Private Practice
- Education
- Other, 2023
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1700 University Ave W
Saint Paul, MN 55104-3727
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251120001996 | MN | Practitioner - Occupational Therapist in Private Practice | 4688947187 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3961026 | WI | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fairview Express Care | Current |
Accepting new patients | |
| Fairview Express Care | Current |
Accepting new patients | |
| St Croix County | Past | Accepting new patients |
Locations
2945 Hazelwood St
Ste 320
Maplewood, MN 55109
Phone (612) 273-1172
717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 3961026 | WI | Yes |
Addresses
Primary practice location
505 Keller Ave S
Amery, WI 54001
Mailing address
505 Keller Ave S
Amery, WI 54001
Phone (715) 268-6900
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6403644 | Other | MEDICA INS | |
| 156L4BR | Other | BCBS OF MN | |
| 40864600 | Medicaid | WI | |
| HP48075 | Other | HEALTH PARTNERS |
Other providers in Amery, WI
- Lynnette A Barrineau
- Matthew Bogan
- Jessica L Bradford
- Brenda Gail Brandt
- Theresa Briggs
- Cheryl Rose Buechner
- Julie B. Burbach
- Erica L Burger
- Jonathan S. Burns
- Danielle R Busse-Quenan
All providers in Amery, WI · Occupational Therapist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.