Provider Demographics
NPI:1659502656
Name:MUELLER, DEANNA (OTR)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:MUELLER
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 1:1300 N PROSPECT AVE APT 420
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3049
Mailing Address - Country:US
Mailing Address - Phone:262-617-1149
Mailing Address - Fax:
Practice Address - Street 1:1300 N PROSPECT AVE APT 420
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-3049
Practice Address - Country:US
Practice Address - Phone:262-671-1149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-07
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2668-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1009698OtherNATIONAL BOARD FOR CERTIFICATION IN OT
WI40780100Medicaid
WI2668-026OtherWI OT LICENSE