Provider Demographics
NPI:1003993809
Name:THE ARC OF FOND DU LAC
Entity Type:Organization
Organization Name:THE ARC OF FOND DU LAC
Other - Org Name:ASSOCIATED PEDIATRIC THERAPISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:L
Authorized Official - Last Name:HANDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-929-8858
Mailing Address - Street 1:500 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-1943
Mailing Address - Country:US
Mailing Address - Phone:920-929-8858
Mailing Address - Fax:920-923-3038
Practice Address - Street 1:500 N PARK AVE
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-1943
Practice Address - Country:US
Practice Address - Phone:920-929-8858
Practice Address - Fax:920-923-3038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5225-0242251P0200X
WI2130225XP0200X
WI1962-154235Z00000X
WI2236-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41211100Medicaid
WI41211100Medicaid