Provider Demographics
NPI:1528024767
Name:BLUSKE, JENNIFER (OTR)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BLUSKE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:KRULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:639 STRUCK ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1383
Mailing Address - Country:US
Mailing Address - Phone:608-234-5990
Mailing Address - Fax:608-234-5990
Practice Address - Street 1:639 STRUCK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1383
Practice Address - Country:US
Practice Address - Phone:608-234-5990
Practice Address - Fax:608-234-5990
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3248-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40817600Medicaid