Provider Demographics
NPI:1760077945
Name:BRUCKBAUER, ANNA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:
Last Name:BRUCKBAUER
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 1:9122 W DIXON ST APT 101
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53214-1360
Mailing Address - Country:US
Mailing Address - Phone:608-206-5293
Mailing Address - Fax:
Practice Address - Street 1:9122 W DIXON ST APT 101
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-1360
Practice Address - Country:US
Practice Address - Phone:608-206-5293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI225X00000X
WI746483225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist