Provider Demographics
NPI:1700390036
Name:WIERSGALLA, ANNE JONES (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:JONES
Last Name:WIERSGALLA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:JONES
Other - Last Name:LINSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2981 CAHILL MAIN APT 112
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-7156
Mailing Address - Country:US
Mailing Address - Phone:608-289-3995
Mailing Address - Fax:608-527-1999
Practice Address - Street 1:2981 CAHILL MAIN APT 112
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-7156
Practice Address - Country:US
Practice Address - Phone:608-289-3995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056009955225X00000X
WI6127-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist