Provider Demographics
NPI:1376812446
Name:HENDERSON, ANNE MARIE (OTR)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:HENDERSON
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 1:6901 205TH TRL
Mailing Address - Street 2:
Mailing Address - City:ALBIA
Mailing Address - State:IA
Mailing Address - Zip Code:52531-8707
Mailing Address - Country:US
Mailing Address - Phone:563-370-8481
Mailing Address - Fax:
Practice Address - Street 1:6001 ALDERSON ST
Practice Address - Street 2:
Practice Address - City:SCHOFIELD
Practice Address - State:WI
Practice Address - Zip Code:54476-3614
Practice Address - Country:US
Practice Address - Phone:715-359-4257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5085-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist