Provider Demographics
NPI:1154314466
Name:HILDENBRAND, SHERESE D (OT)
Entity Type:Individual
Prefix:MRS
First Name:SHERESE
Middle Name:D
Last Name:HILDENBRAND
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 W MEQUON RD
Mailing Address - Street 2:STE 102
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3264
Mailing Address - Country:US
Mailing Address - Phone:262-240-1202
Mailing Address - Fax:262-240-1205
Practice Address - Street 1:1516 W MEQUON RD
Practice Address - Street 2:STE 102
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3264
Practice Address - Country:US
Practice Address - Phone:262-240-1202
Practice Address - Fax:262-240-1205
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI738-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000283140OtherPTAN