Provider Demographics
NPI:1124186259
Name:DECKER, ANN PATRICE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:PATRICE
Last Name:DECKER
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:PO BOX 10
Mailing Address - Street 2:REHAB CARE PARKVIEW HEALTH CENTER 725 BUTLER AVE
Mailing Address - City:WINNEBAGO
Mailing Address - State:WI
Mailing Address - Zip Code:54985-0010
Mailing Address - Country:US
Mailing Address - Phone:920-235-5100
Mailing Address - Fax:920-233-7352
Practice Address - Street 1:725 BUTLER AVE
Practice Address - Street 2:REHAB CARE PARKVIEW HEALTH CENTER
Practice Address - City:WINNEBAGO
Practice Address - State:WI
Practice Address - Zip Code:54985-0010
Practice Address - Country:US
Practice Address - Phone:920-235-5100
Practice Address - Fax:920-233-7352
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI25026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40666600Medicaid