Provider Demographics
NPI:1164825113
Name:REUTER, ANN
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:REUTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 PLEASANT LN
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-2439
Mailing Address - Country:US
Mailing Address - Phone:800-995-2673
Mailing Address - Fax:888-979-6551
Practice Address - Street 1:789 PLEASANT LN
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-2439
Practice Address - Country:US
Practice Address - Phone:800-995-2673
Practice Address - Fax:888-979-6551
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIOT 60291019225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist