Provider Demographics
NPI:1760648661
Name:CAREY, DEANNA RAE (OTR-L)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:RAE
Last Name:CAREY
Suffix:
Gender:F
Credentials:OTR-L
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:RAE
Other - Last Name:BONGARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, OTR/L
Mailing Address - Street 1:1320 WISCONSIN ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-1861
Mailing Address - Country:US
Mailing Address - Phone:715-386-4528
Mailing Address - Fax:
Practice Address - Street 1:1320 WISCONSIN ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-1861
Practice Address - Country:US
Practice Address - Phone:715-386-4528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5304-26225X00000X
MN103489225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN173439300Medicaid
MNC03086Medicare PIN