Provider Demographics
NPI:1609042936
Name:FEENEY, ROSE MARY (OTR)
Entity Type:Individual
Prefix:MS
First Name:ROSE
Middle Name:MARY
Last Name:FEENEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4033 123RD ST
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-6756
Mailing Address - Country:US
Mailing Address - Phone:715-831-0106
Mailing Address - Fax:715-831-0108
Practice Address - Street 1:4033 123RD ST
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-6756
Practice Address - Country:US
Practice Address - Phone:715-831-0106
Practice Address - Fax:715-831-0108
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2344-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40776100Medicaid