MRS. TRACY RAE JOHANNECK-UTPHALL (NPI# 1730416769) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730416769 |
| Entity Type | Individual |
| Full Name | MRS. TRACY RAE JOHANNECK-UTPHALL |
| Other Name | MISS TRACY RAE JOHANNECK |
| Credential | COTA |
| Practice Address |
3248 Shortridge Dr Racine WI 53402-1367 |
| Practice Telephone | 4145506670 |
| Mailing Telephone | 4145506670 |
| Enumeration Date | 2009-11-12 |
| Last Update Date | 2009-11-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 224Z00000X | Occupational Therapy Assistant | 1193-27 | WI | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | WISCONSIN LICIENSURE | 1193-27 | 01 |
| Street Address |
3248 SHORTRIDGE DR |
| City | RACINE |
| State | WI |
| Zip Code | 53402-1367 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215586847 | Jennifer Ann Wagener | Technician | 1513 Melvin Ave, Racine, WI 53402 | 2019-09-06 |
| 1023530490 | Tahir Vora | Pharmacist | 6840 Middle Rd Apt 8, Racine, WI 53402 | 2017-07-07 |
| 1154852069 | Golden Path Services | Home Health | 1700 North Main Street, Upper, Racine, WI 53402 | 2017-03-22 |
| 1376842690 | Vashir Jim Xiong | Acupuncturist | 3726 Ruby Ave, Racine, WI 53402 | 2011-03-25 |
| 1215248927 | Andrew M Asbury | Family Medicine | 2408 Four Mile Rd, Racine, WI 53402 | 2010-06-28 |
| 1215058532 | Lakeshore Family Dental Care Sc | Dentist | 3903 Douglas Ave, Racine, WI 53402 | 2007-04-03 |
| 1679626915 | David Ramon Reesman | Dentist | 3900 North Bay Dr, Racine, WI 53402 | 2007-01-19 |
| 1639286958 | Mary E Pagano | Internal Medicine | 5333 Douglas Ave, Racine, WI 53402 | 2006-08-23 |
| 1881605111 | Caledonia Chiropractic Clinic, Sc | Chiropractor | 5401 Douglas Ave, Suite A, Racine, WI 53402 | 2006-08-11 |
| 1003923996 | David C Zablotney | Family Medicine | 5333 Douglas Ave, Racine, WI 53402 | 2006-08-24 |
| Find all providers in zip 53402 | ||||
| Taxonomy Code | 224Z00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Occupational Therapy Assistant |
| An occupational therapy assistant is a person who has graduated from an occupational therapy assistant program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) or predecessor organizations, has successfully completed a period of supervised fieldwork experience required by the accredited occupational therapy assistant program, has passed a nationally recognized entry-level examination for occupational therapy assistants, and fulfills state requirements for licensure, certification, or registration. An occupational therapy assistant provides interventions under the supervision of an occupational therapist which emphasize the therapeutic use of everyday life activities (i.e., occupations) with individuals or groups for the purpose of facilitating participation in roles and situations and in home, school, workplace, community and other settings. Occupational therapy services are provided for the purpose of promoting health and wellness and are provided to those who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction. Occupational therapy assistants address the physical, cognitive, psychosocial, sensory, and other aspects of occupational performance in a variety of contexts to support engagement in everyday life activities that affect health, well-being, and quality of life. |
| Notes: Source: The Guide to Occupational Therapy Practice, 2nd edition. Bethesda: American Occupational Therapy Association, 2007. [7/1/2008: definition changed, source changed] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275754848 | Sara Beth Schattner | Occupational Therapy Assistant | 1700 C.a. Becker Drive, Racine, WI 53406 | 2007-05-01 |
| 1225256605 | Danielle Marie Weber | Occupational Therapy Assistant | 1700 C A Becker Dr, Racine, WI 53406-4714 | 2007-04-23 |
| 1851861504 | Ashley Liebe | Occupational Therapy Assistant | 1320 S Green Bay Road, Racine, WI 53406 | 2018-11-26 |
| 1841738028 | Mary Harris | Occupational Therapy Assistant | 1320 Wisconsin Ave, Racine, WI 53403-1978 | 2017-02-07 |
| 1114306214 | Lionel Thompson | Occupational Therapy Assistant | 6101 16th St, Racine, WI 53406-4467 | 2015-05-21 |
| 1144621574 | Jennifer Neisner | Occupational Therapy Assistant | 1700 C A Becker Dr, Racine, WI 53406-4714 | 2014-09-04 |
| 1760819734 | Matthew Dennis Lefever | Occupational Therapy Assistant | 6101 16th St, Racine, WI 53406-4467 | 2013-10-04 |
| 1952740433 | Jessica Leckie | Occupational Therapy Assistant | 3205 Wood Rd, Racine, WI 53406-5048 | 2013-06-18 |
| 1598097818 | Karen Sue Allen | Occupational Therapy Assistant | 3205 Wood Rd, Racine, WI 53406-5048 | 2010-02-11 |
| 1760633937 | Katie Fiona Jerdee | Occupational Therapy Assistant | 3205 Wood Rd, Racine, WI 53406-5048 | 2008-10-07 |
| Find all providers in RACINE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.