Provider Demographics
NPI:1437328697
Name:KUZMA, ANNE M (OT)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:KUZMA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:M
Other - Last Name:CYCHOSZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54702-1510
Mailing Address - Country:US
Mailing Address - Phone:715-838-5222
Mailing Address - Fax:
Practice Address - Street 1:310 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:WI
Practice Address - Zip Code:54656
Practice Address - Country:US
Practice Address - Phone:608-269-1770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103570225X00000X
WI4807225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
670000553Medicare PIN
MNENROLLEDMedicaid