Provider Demographics
NPI:1790902757
Name:SHEA, JUDY ANN (OTR)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:ANN
Last Name:SHEA
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:W184S8630 DENICE CT S
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-8713
Mailing Address - Country:US
Mailing Address - Phone:262-679-6472
Mailing Address - Fax:
Practice Address - Street 1:S77W12929 MCSHANE DR
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-4039
Practice Address - Country:US
Practice Address - Phone:414-529-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3830-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist