Provider Demographics
NPI:1093753022
Name:PLUNKETT, JEANNE (OTR)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:PLUNKETT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6083 WHITE BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:WI
Mailing Address - Zip Code:54540-9549
Mailing Address - Country:US
Mailing Address - Phone:715-617-6216
Mailing Address - Fax:715-547-3334
Practice Address - Street 1:6083 WHITE BIRCH DR
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:WI
Practice Address - Zip Code:54540-9549
Practice Address - Country:US
Practice Address - Phone:715-617-6216
Practice Address - Fax:715-547-3334
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1516-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40677900Medicaid