Provider Demographics
NPI:1144391483
Name:VANLANEN, TERESA M (OT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:M
Last Name:VANLANEN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:M
Other - Last Name:EASTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7222
Mailing Address - Fax:
Practice Address - Street 1:575 4TH ST
Practice Address - Street 2:
Practice Address - City:KEWAUNEE
Practice Address - State:WI
Practice Address - Zip Code:54216-1785
Practice Address - Country:US
Practice Address - Phone:920-388-4640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4108OtherLICENSE