Provider Demographics
NPI:1699839092
Name:SANCHEZ MORET, VIRGINIA Y (OTR)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:Y
Last Name:SANCHEZ MORET
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 1:1551 HONEYSUCKLE RD APT 5
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53027-2660
Mailing Address - Country:US
Mailing Address - Phone:262-670-6291
Mailing Address - Fax:
Practice Address - Street 1:2300 STATE ROAD 44
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-9137
Practice Address - Country:US
Practice Address - Phone:920-233-2372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2233-026174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2233-026OtherWI DEPT. OF REG.