Provider Demographics
NPI:1760660377
Name:PAUSE FOR HEALING, LLC
Entity Type:Organization
Organization Name:PAUSE FOR HEALING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:JO
Authorized Official - Last Name:LINDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:414-254-1565
Mailing Address - Street 1:13965 W BURLEIGH RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-3064
Mailing Address - Country:US
Mailing Address - Phone:414-254-1565
Mailing Address - Fax:262-378-4394
Practice Address - Street 1:13965 W BURLEIGH RD
Practice Address - Street 2:SUITE 103
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-3064
Practice Address - Country:US
Practice Address - Phone:414-254-1565
Practice Address - Fax:262-378-4394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1861594210OtherINDIVIDUAL NPI
WI40898800Medicaid
1861594210OtherINDIVIDUAL NPI