Provider Demographics
NPI:1558592345
Name:WEISHAN, JUDY ANN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:ANN
Last Name:WEISHAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:JUDY
Other - Middle Name:ANN
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:516 GALWAY TER
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53527-8109
Mailing Address - Country:US
Mailing Address - Phone:608-345-6179
Mailing Address - Fax:
Practice Address - Street 1:41 RICKEL RD
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-1840
Practice Address - Country:US
Practice Address - Phone:608-837-8529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI563-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1558592345Medicaid