Provider Demographics
NPI:1790935716
Name:RIVERWIND THERAPEUTICS, LLC
Entity Type:Organization
Organization Name:RIVERWIND THERAPEUTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUYNE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR
Authorized Official - Phone:608-290-4584
Mailing Address - Street 1:828 E AZALEA TER
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1606
Mailing Address - Country:US
Mailing Address - Phone:608-290-4584
Mailing Address - Fax:608-362-6065
Practice Address - Street 1:828 E AZALEA TER
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-1606
Practice Address - Country:US
Practice Address - Phone:608-290-4584
Practice Address - Fax:608-362-6065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2095-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty