Provider Demographics
NPI:1609895283
Name:BECKER, ANNE (OTR)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:BECKER
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 1:11057 N TOWNE SQUARE RD
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-5051
Mailing Address - Country:US
Mailing Address - Phone:262-241-7887
Mailing Address - Fax:262-241-7884
Practice Address - Street 1:11057 N TOWNE SQUARE RD
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5051
Practice Address - Country:US
Practice Address - Phone:262-241-7887
Practice Address - Fax:262-241-7884
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3779-020225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0005 86660Medicare ID - Type Unspecified