Provider Demographics
NPI:1760641948
Name:KLINGLER, MICHELLE A (OT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:KLINGLER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2398 NORWAY POINT RD
Mailing Address - Street 2:
Mailing Address - City:PELICAN LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54463-9401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:729 PARK ST
Practice Address - Street 2:
Practice Address - City:ANTIGO
Practice Address - State:WI
Practice Address - Zip Code:54409-2745
Practice Address - Country:US
Practice Address - Phone:715-623-2356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3709 026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40854600Medicaid