Provider Demographics
NPI:1720565146
Name:ORNELAS, ISAMAR ORNELAS (MS OTR)
Entity Type:Individual
Prefix:
First Name:ISAMAR
Middle Name:ORNELAS
Last Name:ORNELAS
Suffix:
Gender:F
Credentials:MS OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 N 26TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-1507
Mailing Address - Country:US
Mailing Address - Phone:414-881-5404
Mailing Address - Fax:
Practice Address - Street 1:833 N 26TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1507
Practice Address - Country:US
Practice Address - Phone:414-881-5404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6122-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI6122-26OtherSTATE OF WISCONSIN LICENSE