Provider Demographics
NPI:1407186653
Name:VINSON, TASHA DENISE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:TASHA
Middle Name:DENISE
Last Name:VINSON
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 1:9632 W. APPLETON AVE
Mailing Address - Street 2:BIRCHWOOD HEALTHCARE AND REHAB CENTER
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225
Mailing Address - Country:US
Mailing Address - Phone:414-535-6704
Mailing Address - Fax:414-535-6952
Practice Address - Street 1:9632 W APPLETON AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-3305
Practice Address - Country:US
Practice Address - Phone:414-535-6704
Practice Address - Fax:414-535-6952
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4834-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist