Provider Demographics
NPI:1609017524
Name:BEISTLE, CAROL A (OTR/CHT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:BEISTLE
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 1:5286 INDIAN DR
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53027-9588
Mailing Address - Country:US
Mailing Address - Phone:262-644-6002
Mailing Address - Fax:
Practice Address - Street 1:5286 INDIAN DR
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:WI
Practice Address - Zip Code:53027-9588
Practice Address - Country:US
Practice Address - Phone:262-644-6002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1692026225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation