Provider Demographics
NPI:1407373335
Name:RUPRECHT, LEEANNA MAE (COTA)
Entity Type:Individual
Prefix:
First Name:LEEANNA
Middle Name:MAE
Last Name:RUPRECHT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4481 S RIVORD RD
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-8092
Mailing Address - Country:US
Mailing Address - Phone:715-699-5993
Mailing Address - Fax:
Practice Address - Street 1:35 N 28TH ST
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-5557
Practice Address - Country:US
Practice Address - Phone:715-392-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4520-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant