Provider Demographics
NPI:1235364688
Name:ROMANOWSKI, LAURIE ANN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:ANN
Last Name:ROMANOWSKI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W4533 BASSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-3910
Mailing Address - Country:US
Mailing Address - Phone:262-248-3278
Mailing Address - Fax:
Practice Address - Street 1:211 S CURTIS ST
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-2052
Practice Address - Country:US
Practice Address - Phone:262-248-3145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3277-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1235364688Medicaid