Provider Demographics
NPI:1467840694
Name:RUEBSAMEN, COLLEEN CLARICE (OTR, CHT)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:CLARICE
Last Name:RUEBSAMEN
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S7071 AIKINS RD
Mailing Address - Street 2:
Mailing Address - City:READSTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:54652-8046
Mailing Address - Country:US
Mailing Address - Phone:608-637-4385
Mailing Address - Fax:
Practice Address - Street 1:507 S MAIN ST
Practice Address - Street 2:
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665-2059
Practice Address - Country:US
Practice Address - Phone:608-637-2101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3932-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist