Healthcare Provider Details

I. General information

NPI: 1497319941
Provider Name (Legal Business Name): CARISSA A SOMMER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2414 KOHLER MEMORIAL DR
SHEBOYGAN WI
53081-3129
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 920-457-4461
  • Fax:
Mailing address:
  • Phone: 920-457-4461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6492
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number6492-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: