Provider Demographics
NPI:1285823161
Name:JOHN, ANN V (OTR)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:V
Last Name:JOHN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4922 COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-9188
Mailing Address - Country:US
Mailing Address - Phone:262-377-4077
Mailing Address - Fax:262-377-7358
Practice Address - Street 1:4922 COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-9188
Practice Address - Country:US
Practice Address - Phone:262-377-4077
Practice Address - Fax:262-377-7358
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1166225X00000X, 225XE1200X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41213500OtherMEDICAID GROUP #
WI40643000Medicaid
WI391550272010OtherBCBS GROUP BILLING NUMBER