Basic Information
| Provider Information | |||||||||
| NPI: | 1497319941 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOMMER | ||||||||
| FirstName: | CARISSA | ||||||||
| MiddleName: | ASHLEIGH | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 620 SCHOENHAAR DR | ||||||||
| Address2: | |||||||||
| City: | WEST BEND | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530902649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9202541683 | ||||||||
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| Practice Location | |||||||||
| Address1: | 620 SCHOENHAAR DR | ||||||||
| Address2: | |||||||||
| City: | WEST BEND | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530902649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2623068450 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2019 | ||||||||
| LastUpdateDate: | 11/20/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0200X | 6492-26 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 6492-26 | 01 | WI OTR/L LICENSE NUMBER | OTHER |