Provider Demographics
NPI:1619098894
Name:OSBORNE, JOCELYN MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:MARIE
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JOCELYN
Other - Middle Name:M
Other - Last Name:WOZNICKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3915 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-1957
Mailing Address - Country:US
Mailing Address - Phone:262-657-0222
Mailing Address - Fax:262-657-7190
Practice Address - Street 1:237 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TWIN LAKES
Practice Address - State:WI
Practice Address - Zip Code:53181-9681
Practice Address - Country:US
Practice Address - Phone:262-877-4884
Practice Address - Fax:262-877-4629
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.013399225100000X
WI9729-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI859400062OtherMEDICARE