Provider Demographics
NPI:1235279902
Name:FLEMMING-COBURN, ANNE (MOT, OTR, CLM)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:FLEMMING-COBURN
Suffix:
Gender:F
Credentials:MOT, OTR, CLM
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:FLEMMING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MOT, OTR, CLM
Mailing Address - Street 1:1461 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHITEWATER
Mailing Address - State:WI
Mailing Address - Zip Code:53190-1568
Mailing Address - Country:US
Mailing Address - Phone:262-473-5599
Mailing Address - Fax:
Practice Address - Street 1:1461 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-1568
Practice Address - Country:US
Practice Address - Phone:262-473-5599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3881-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41030800Medicaid