Provider Demographics
NPI:1235258633
Name:GRABOWSKI, NISSA DEE (OTR)
Entity Type:Individual
Prefix:
First Name:NISSA
Middle Name:DEE
Last Name:GRABOWSKI
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:NISSA
Other - Middle Name:DEE
Other - Last Name:MCWILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:501 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4039
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 N 10TH ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-4039
Practice Address - Country:US
Practice Address - Phone:608-239-8481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3482-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40829200Medicaid