Provider Demographics
NPI:1033994629
Name:SPLITTGERBER, PAIGE NICOLE (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:NICOLE
Last Name:SPLITTGERBER
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 ALCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:HOWARDS GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53083-1425
Mailing Address - Country:US
Mailing Address - Phone:920-980-8334
Mailing Address - Fax:
Practice Address - Street 1:3360 GATEWAY RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-5115
Practice Address - Country:US
Practice Address - Phone:262-923-7101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8386-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist