Provider Demographics
NPI:1295836310
Name:HABETLER, REBECCA J (OTR)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:J
Last Name:HABETLER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:J
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 13508
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54307-3508
Mailing Address - Country:US
Mailing Address - Phone:920-433-0111
Mailing Address - Fax:920-433-8765
Practice Address - Street 1:900 S WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3508
Practice Address - Country:US
Practice Address - Phone:920-433-0111
Practice Address - Fax:920-433-8765
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2428-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40809400Medicaid