Provider Demographics
NPI:1598246688
Name:GENDREAU, CATHERINE ISABEL (MSOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ISABEL
Last Name:GENDREAU
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:PORT EDWARDS
Mailing Address - State:WI
Mailing Address - Zip Code:54469-1028
Mailing Address - Country:US
Mailing Address - Phone:715-323-1363
Mailing Address - Fax:
Practice Address - Street 1:3541 PLOVER RD
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-2155
Practice Address - Country:US
Practice Address - Phone:715-407-4660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7305-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist