Provider Demographics
NPI:1710151667
Name:IKELER, DIANN LOUISE (OTR)
Entity Type:Individual
Prefix:
First Name:DIANN
Middle Name:LOUISE
Last Name:IKELER
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:S94W31656 GENA DR
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-8273
Mailing Address - Country:US
Mailing Address - Phone:414-588-9466
Mailing Address - Fax:
Practice Address - Street 1:S94W31656 GENA DR
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-8273
Practice Address - Country:US
Practice Address - Phone:414-588-9466
Practice Address - Fax:262-378-5101
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1970-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40783900Medicaid
WI1970-026OtherOCCUPATIONAL THERAPIST LICENSE