Provider Demographics
NPI:1366677734
Name:PAVLOVIC, DARLENE (OTR)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:PAVLOVIC
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:DARLENE
Other - Middle Name:
Other - Last Name:RUDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1650 TRI PARK WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-1652
Mailing Address - Country:US
Mailing Address - Phone:920-830-6697
Mailing Address - Fax:920-830-6707
Practice Address - Street 1:1650 TRI PARK WAY
Practice Address - Street 2:SUITE A
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-1652
Practice Address - Country:US
Practice Address - Phone:920-830-6697
Practice Address - Fax:920-830-6707
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI270-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist